Fact Sheet: New Coverage Guidelines for Noninvasive Ventilation in the Home for the Treatment of COPD

August 20, 2025

By: John M. Coleman III, MD
Associate Professor of Medicine and Neurology, Division of Pulmonary and Critical Care Medicine
Medical Director, Respiratory Care, Northwestern University Feinberg School of Medicine

On June 10, 2025, the Centers for Medicare and Medicaid Services finalized a new national coverage document that establishes Medicare coverage criteria for the use of two types of ventilation devices—home mechanical ventilators (HMVs) and respiratory assist devices—for patients with COPD. Effective immediately, the new criteria help guide clinicians to get the right device to the right patient. This fact sheet outlines key updates that clinicians need to know.

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• PaCO₂ levels above 45 mmHg in patients with COPD are associated with increased mortality.
• Bilevel positive airway pressure with a backup rate is associated with lower mortality, higher quality of life, and reduced dyspnea.
• Bilevel positive airway pressure with a backup rate is associated with reduced hospitalizations and a reduced need for intubation during hospitalization.
• A backup rate sustains nocturnal ventilation during physiological suppression of respiratory drive during sleep that can lead to hypoventilation.
• There are two main options for delivering noninvasive positive pressure ventilation (NIPPV) in patients with COPD: a bilevel positive airway pressure (BPAP) device or home mechanical ventilator (HMV).
• HMVs have internal batteries, more sophisticated alarms and monitoring, and the capability to generate greater pressure than bilevel positive airway pressure devices, but they have a much higher cost.

New criteria for coverage of NIPPV in the treatment of chronic respiratory failure consequent to COPD:

• Removal of the prior requirement to perform overnight oximetry to document nocturnal hypoxemia.
• COPD patients are eligible
  • If they have hypercapnia of PaCO₂ 52 mmHg (based on arterial blood gas), or
  • If sleep apnea is not the predominant cause of hypercapnia (based on documentation), or
  • If either stable COPD or hypercapnia is present at least two weeks following their hospitalization after resolution of a COPD exacerbation.
• Evaluation within six months of starting NIPPV and must show
  • Normalization of PaCO₂, or
  • Stabilization of rising PaCO₂, or
  • 20% reduction in PaCO₂ from baseline, or
  • Improvement in symptoms associated with chronic hypercapnia.
• An HMV is indicated if the patient
  • Requires O₂ therapy of FiO₂ 36% or  4L nasally,
  • Requires ventilatory support for more than 8 hours/day, or
  • Requires the alarms or internal battery of an HMV.
• Continued use of either a BPAP device or HMV requires usage of at least 4 hours/day on at least 70% of days each month.