06/18/2025
What is new: As of April 1, 2025, procedure code E0468, rentals of dual-function home ventilators, is a benefit of Texas Medicaid.
Highlights: Rentals of dual-function home ventilators are covered with a limit of one per month:
- Procedure code E0468 – home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components and supplies for all functions.
- Medical necessity criteria are required for members, all ages, for both a mechanical ventilator and a cough augmentation device.
Effective July 1, 2025, the following procedure codes are considered bundled in the rental for dual-function ventilators. They will be published in the Texas Medicaid Provider Procedures Manual:
If you have questions: Call our Medicaid Provider Network Team at 855-212-1615 or email Texas Medicaid Network Department.
The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.
