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Reimbursement Coverage for AffloVest

AffloVest requires a doctor’s prescription for treatment by High Frequency Chest Wall Oscillation (HFCWO). The AffloVest has received the FDA’s 510k clearance for U.S. market availability, and is approved for Medicare, Medicaid, and private health insurance reimbursement under the Healthcare Common Procedure Coding System(HCPCS) code E0483 – High Frequency Chest Wall Oscillation. The AffloVest is also available through the U.S Department of Veterans Affairs/Tricare. Patients must qualify to meet insurance eligibility requirements.

According to the Medicare LCD (other insurances may vary), the following must all be well documented in the Medical Record itself:

DIAGNOSIS

Patient must be diagnosed with a condition such as Bronchiectasis (which has been confirmed by a CT scan), or Cystic Fibrosis, Multiple Sclerosis, Muscular Dystrophy or other neuromuscular diseases (View a full list of Medicare approved ICD10 Codes for HFCWO E0483  here).

  • Chronic bronchitis and chronic obstructive pulmonary disease (COPD) in the absence of a confirmed diagnosis of bronchiectasis do not meet this criterion.

REASON(S) FOR ORDERING AFFLOVEST

If the primary diagnosis is Bronchiectasis, Signs & Symptoms of one of the following must be met:

  • Daily productive (mucus) cough for at least 6 continuous months in the year prior to the date of the order; OR
  • Frequent (i.e. more than 2/year) exacerbations/chest infections (such as Pneumonia) requiring antibiotic therapy in the year prior to the date of the order

If Cystic Fibrosis or an approved Neuromuscular diagnosis is primary: chart notes to support the diagnosis are required.

TRIED AND FAILED AIRWAY CLEARANCE

Documentation (chart notes) of another airway clearance treatment tried to mobilize secretions and clearly indicating that the other device has failed.

  1. Which Airway Clearance Therapies have been “tried and failed” for the patient?
  • CPT (Manual or Percussor) • PEP (Acapella®/Flutter®) • CoughAssist • Autogenic Drainage • “Huff Cough” • Postural Drainage • use of Mucomist (Acetylcysteine), and hypertonic saline can be used for tried and failed as long as there is documentation these were used for airway clearance and ineffective.
  1. Include all reasons why the above therapy is ineffective or didn’t help for the mobilization of secretions.

TREATMENT PLAN

Recommendation for AffloVest HFCWO therapy including frequency of use for treatments as recommended by the practitioner.

Once delivered, Continued Need and Continued Use criteria (just like all other forms of DME equipment) must be met. This is not the same as compliance like a CPAP device.

2019-08-08T20:07:59+00:00
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