01Already effective March 16, 2026: Billing team, for high frequency chest wall compression devices and IPV devices, confirm the chart documents a diagnosis that impairs clearance of secretions (such as cystic fibrosis, ciliary dyskinesia, neuromuscular disorder or diffuse bronchiectasis), a demonstrated need with exacerbations of respiratory distress involving inability to clear mucus effectively, and failure of, contraindication to, or lack of available resources for standard treatments such as pharmacotherapy, postural drainage, daily chest percussion, the Flutter Valve or the Acapella device.
02For mechanical insufflation-exsufflation devices, confirm the patient has a neuromuscular disorder, high spinal cord injury or intrinsic lung disease, is unable to cough or clear secretions effectively using manual cough assistive techniques, has a peak cough expiratory flow below 300 liters per minute, and has no contraindications such as a history of bullous emphysema or susceptibility to pneumothorax or pneumomediastinum.
03For repair of equipment not under warranty, physician documentation must include the date of DME initiation, manufacturer warranty information if applicable, and an attestation that the patient has been compliant and will continue to benefit; the DME must no longer function adequately, the inadequate function must interfere with activities of daily living, and repair must be expected to make the equipment fully functional.
04For replacement, the device must no longer function adequately and be non-repairable or have repair cost above replacement cost, or the documentation must show a change in the patient's condition that makes the unit non-functional with improvement expected from a replacement.
05Prior authorization and coverage are contract dependent unless mandated by federal or state mandate, and the referral must be generated by a pulmonologist.
06Codes may not be covered under all circumstances.
07The policy lists its next review for November 2026, so check the source link for the current version.