1. Patient must demonstrate critically impaired breathing capacity
   1. VC <= 30% of normal
   2. Dyspnea at rest
   3. Supplemental O2 at rest
2. Rapid progression of ALS and critical nutritional impairment
   1. independent to wheelchair or bedbound
   2. unintelligible speech
   3. normal to pureed diet
   4. Major assistance with ADLs
3. Rapid progression of ALS and life threatening complications
   1. aspiration pneumonia
   2. upper UTI
   3. Sepsis
   4. Recurrent fewer after antibiotic therapy

Medicare Local Coverage Determination (LCD) for Neurological Disorder