Outpatient Specialty and Home Health Referrals
Go to Discharge tab —> Order Reconciliation —> search “Amb ref to ” Home Health or desired specialty.
Meds to Beds
- Call Meds-to-Beds pharmacist at
x2959 - Pharmacy will review eligibility and change EPIC Pharmacy Routing to
St Peters Health - Broadway - Send medications per usual DC_Workflow > 4. Perform Med Rec and Check Appropriate Pharmacy
Holter / Cardiac Monitors
Notify Shelly Boyd of need and she will set up the rest.
BiPAP (E0470 / E0471) Device Qualification Criteria
Source: CMS Local Coverage Determination — scanned document
Severe COPD
E0470 (BiPAP) is covered if criteria A–C are met:
- A. ABG PaCO₂ ≥ 52 mmHg (awake, on prescribed FiO₂)
- B. Sleep oximetry: SpO₂ ≤ 88% for ≥ 5 cumulative minutes (min 2 hr recording) on O₂ at 2 LPM or prescribed FiO₂
- C. OSA ruled out as predominant cause of hypercapnia/desaturation
Covered for first 3 months if all criteria met.
E0471 (BiPAP with backup rate) — covered in either situation:
Situation 1: Qualified for E0470, then:
- A. PaCO₂ worsens ≥ 7 mmHg vs original on ABG
- B. Facility PSG: SpO₂ ≤ 88% for ≥ 5 min while using E0470, NOT caused by OSA (AHI < 5)
Situation 2: ≥ 61 days after E0470 issue:
- A. PaCO₂ still ≥ 52 mmHg
- B. Sleep oximetry while using E0470: SpO₂ ≤ 88% for ≥ 5 min
Hypoventilation Syndrome
E0470 covered if A + B + (C or D):
- A. ABG PaCO₂ ≥ 45 mmHg (awake, prescribed FiO₂)
- B. FEV₁/FVC ≥ 70% (if <70%, see Severe COPD criteria)
- C. Sleep/awakening ABG: PaCO₂ worsens ≥ 7 mmHg vs A
- D. Facility PSG/HST: SpO₂ ≤ 88% for ≥ 5 min, non-obstructive (AHI < 5)
E0471 covered if A + B + (C or D):
- A. Covered E0470 in use
- B. FEV₁/FVC ≥ 70%
- C. Awake ABG: PaCO₂ worsens ≥ 7 mmHg vs qualifying ABG
- D. Facility PSG/HST: SpO₂ ≤ 88% for ≥ 5 min (non-obstructive) while using E0470
Restrictive Thoracic Disorders
E0470 or E0471 covered if criteria A–C met:
- A. Documented neuromuscular disease (e.g., ALS) or severe thoracic cage abnormality
- B. One of: (a) ABG PaCO₂ ≥ 45 mmHg, or (b) sleep oximetry SpO₂ ≤ 88% for ≥ 5 min, or (c) for neuromuscular disease: MIP < 60 cm H₂O or FVC < 50% predicted
- C. COPD not a significant contributor
Covered for first 3 months. Beyond 3 months, see continued coverage criteria.