What Is NIPPV?
Non-invasive positive pressure ventilation (NIPPV) is a therapy that uses a mask interface to deliver pressurized air to patients with chronic respiratory failure (CRF), particularly those with chronic obstructive pulmonary disease (COPD). Unlike invasive ventilation, NIPPV supports breathing without the need for intubation, making it a preferred option for home-based care.
NIPPV includes devices such as:
- Respiratory assist devices (RADs) – with or without backup rate features
- Home mechanical ventilators (HMVs) – typically used in volume-targeted modes
These therapies help reduce carbon dioxide levels (PaCO2), improve symptoms like fatigue and shortness of breath, and enhance quality of life for patients with advanced COPD.
NIPPV Updates
As of October 22, 2025, CMS has expanded coverage for NIPPV therapies in the home setting. This includes:
- Initial six-month coverage for RADs and HMVs
- Post-hospital discharge coverage
- Ongoing coverage based on usage and clinical improvement
This change represents a significant opportunity for DMEPOS providers to support patients transitioning from hospital to home while also navigating new documentation and billing requirements.
Key Coverage Criteria for DMEPOS Providers
Respiratory Assist Devices (RADs)
- PaCO2 ≥ 52 mmHg while awake and on prescribed oxygen
- Sleep apnea not the primary cause
- Stable COPD or persistent hypercapnia post-hospitalization
- High-intensity therapy required by 6 months (IPAP ≥ 15 cm H2O, backup rate ≥ 14 bpm)
Home Mechanical Ventilators (HMVs)
- For patients whose needs exceed RAD capabilities
- Must meet additional criteria such as:
- Oxygen therapy ≥ 36% FiO2 or ≥ 4L nasal flow
- Ventilatory support > 8 hours/day
- Need for alarms and internal battery
Implications for DMEPOS Providers
This expanded coverage means:
- Increased demand for home ventilation equipment and services
- Greater responsibility for ensuring proper documentation, device setup, and patient education
- New billing codes and modifiers to manage (e.g., E0470, E0465, KX modifier)
Providers must also track:
- Usage compliance (≥ 4 hours/day on ≥ 70% of days)
- Clinical outcomes (PaCO2 reduction, symptom improvement)
Your Partners in Navigating NIPPV
Encore Healthcare has a turnkey solution for tracking clinical outcomes, as required by the new NIPPV policy. Their Nexus software and 360 Telerespiratory Services are helping DMEs:
- Increase length of service on vents (from 8 to over 20 months!)
- Track outcomes and compliance with ease
- Improve patient care while reducing RT burden
Encore Healthcare can help you grow and serve your current patients.
See your growth potential with Nexus.
Trace Medical and Encore Healthcare offer their Vent360 and Vent360+ programs, which is an all-in-one solution that integrates ventilator rentals, Nexus clinical management, and compliance oversight – all under one convenient, all-inclusive monthly price. Their RT Navigator-lead monitoring and intervention and clinical outcomes-focused programs provide monthly documentation of patient-ventilator adherence.
VGM Professional Services helps providers confidently navigate these complexities of the DMEPOS industry, including home-based NIPPV coverage for COPD. Our team offers operational support, including referral templates and intake workflows tailored to RAD and HMV requirements, as well as audit and compliance readiness to ensure proper coverage. VGM also delivers expert billing and reimbursement guidance on HCPCS and ICD-10 coding, modifier usage, and documentation standards—helping providers stay compliant and optimize billing outcomes.
VGM Government Relations plays a vital role in advocating for DMEPOS providers at the federal level. Our team monitors regulatory changes, engages with policymakers, and communicates timely updates on CMS decisions and coverage policies in regard to NIPPV. VGM helps providers stay informed, compliant, and prepared to implement new coverage criteria and documentation standards that directly impact NIPPV delivery in the home.
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