Local Coverage Determination · DME MAC
L33800
Respiratory Assist Devices
Version 43. CMS effective date 06/09/2025. CMS updated 10/22/2025. Read from the CMS Coverage API on 2026-10-13. Contractors on the report: CGS Administrators (DME MAC) and Noridian Healthcare Solutions (DME MAC).
CMS coverage policy citation. CMS Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, Section 240.9
Coverage indication
In addition to the “reasonable and necessary” criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement: The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section. The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section. Refer to the Supplier Manual for additional information on documentation requirements. Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD. For the items addressed in this LCD, the “reasonable and necessary” criteria, based on Social Security Act § 1862(a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity. For purposes of this policy the following definitions are used: - FIO2 is the fractional concentration of oxygen delivered to the beneficiary for inspiration. The beneficiary’s prescribed FIO2 refers to the oxygen concentration the beneficiary normally breathes when not undergoing testing to qualify for coverage of a Respiratory Assist Device (RAD). That is, if the beneficiary does not normally use supplemental oxygen, their prescribed FIO2 is that found in room air. - FEV1 is the forced expired volume in 1 second. - FVC is the forced vital capacity.
Excerpt from the LCD indication. Full text on CMS.
Documentation requirements
Items covered in this LCD have additional policy-specific requirements that must be met prior to Medicare reimbursement. Refer to the LCD-related Policy article, located at the bottom of this policy under the Related Local Coverage Documents section for additional information.
Related articles
- A52517 · Respiratory Assist Devices - Policy Article
- A55426 · Standard Documentation Requirements for All Claims Submitted to DME MACs
- A58822 · Response to Comments: Respiratory Assist Devices - DL33800
Related NCDs
- NCD 240.9 · Noninvasive Positive Pressure Ventilation (NIPPV) in the Home for the Treatment of Chronic Respiratory Failure (CRF) Consequent to Chronic Obstructive Pulmonary Disease (COPD) (version 1)
HCPCS codes on this LCD
18 other Level II codes are on the LCD and are not given a page in this set: E0471, A7028, A7029, A7030, A7031, A7032, A7033, A7034, A7035, A7036, A7037, A7038, A7039, A7044, A7045, A7046, E0561, E0562.
Questions
What does LCD L33800 cover?
L33800 is Respiratory Assist Devices. It is a current final DME MAC local coverage determination, version 43.
Where is the CMS source for L33800?
The Medicare Coverage Database page for LCD L33800 version 43.
Get the signed answer via API
The signed answer is the receipt for this code on a date of service: the rule that was in force, with a hash you can replay. The call needs an API key. The source archive and as-of resolution are public.
curl -H "X-API-Key: $VERZI_API_KEY" \
"https://api.verzi.health/v1/rules/warrant?hcpcs=E0470&as_of=2024-01-15&npi=1234567890&state=UT"