CommercialCoverageHigh impact
Chest Physiotherapy and Airway Clearance Devices (CPB 0067, reviewed 2026-03-18)
Aetna·Pulmonology, Critical Care, Pediatrics +1 more·Medical Policy
Effective date
Mar 18, 2026
We identified it
Aug 15, 2026
Summary
Aetna consolidated three prior chest physiotherapy and airway clearance policies (CPBs 252, 280, 333) into one comprehensive policy (CPB 0067). This policy consolidation clarifies medical necessity criteria for respiratory therapist services, establishes specific indications for airway clearance devices (Flutter, Acapella, mechanical percussors, PEP masks, postural drainage boards), defines requirements for high-frequency chest compression systems, and identifies experimental/investigational devices. Billing teams must verify coverage based on diagnosis, device type, and documented clinical criteria before claim submission.
Action Required
By March 18, 2026: (1) Billing team must update system edits to require diagnosis verification before allowing claims for CPT codes 94667, 94668, 94669, 97124 and HCPCS codes G0237, G0238. (2) Implement requirement to verify patient meets medical necessity criteria: for home chest physiotherapy, document unstable pulmonary condition OR initial prescription for family training; for airway clearance devices, confirm ICD-10 diagnosis matches covered indications (CF, chronic bronchitis, bronchiectasis, immotile cilia syndrome, asthma, COPD as applicable). (3) For high-frequency chest compression systems (AffloVest, SmartVest, etc.), require documentation of failed standard treatments AND one of the specific indications (bronchiectasis with 6+ months productive cough OR 2+ exacerbations/year, CF, immotile cilia syndrome, qualifying neuromuscular disease, or lung transplant within 6 months). (4) Add system flag to DENY claims for experimental devices: BiWaze Clear System (A7021), Intrapulmonary percussive ventilators (IPV), Volara System OLE, and Simeox Airway Clearance Technology for all indications. (5) Update encounter templates and prior authorization forms to include diagnosis codes from listed ICD-10 ranges (E84.0-E84.9, J40-J47.9, Q89.3, etc.). (6) Communicate changes to providers and respiratory therapy vendors. Claims submitted without proper diagnosis documentation or for experimental devices will be denied.