Positive expiratory pressure (PEP) mask for CF, chronic bronchitis, immotile cilia syndrome, asthma, and chronic obstructive pulmonary disease (COPD) Īetna considers high-frequency chest compression systems (e.g., the AffloVest, the Frequencer, the Monarch Airway Clearance System, the SmartVest, the MedPulse Respiratory Vest System, the Vest Airway Clearance System, the ABI Vest, Respin11 Bronchial Clearance System, and the InCourage Vest/System) medically necessary DME in lieu of chest physiotherapy for the following indications, where there is a well documented failure of standard treatments to adequately mobilize retained secretions:.Mechanical percussors (e.g., Fluid Flo, Frequencer, and VibraLung Acoustical Percussor) for CF, chronic bronchitis, bronchiectasis, immotile cilia syndrome, and asthma.Airway oscillating devices (e.g., Flutter and Acapella) for cystic fibrosis (CF), chronic bronchitis, bronchiectasis, immotile cilia syndrome (also known as primary ciliary dyskinesia) and asthma.Note: Chest physiotherapy by a respiratory therapist is not considered medically necessary for persons whose pulmonary condition is stable, as chest physiotherapy can be competently administered at home by a family member or caregiver.Īetna considers the following airway clearance devices medically necessary durable medical equipment (DME) to assist in mobilizing respiratory tract secretions for members with the conditions that are indicated below: Chest physiotherapy when the member’s pulmonary condition is unstable.Home chest physiotherapy upon the initial prescription of chest physiotherapy to stabilize the member and to train family members or caregivers to administer chest physiotherapy.This Clinical Policy Bulletin addresses chest physiotherapy and airway clearance devices.Īetna considers the folowing interventions by a respiratory therapist medically necessary: The making of additional copies is prohibited.(Replaces CPBs 252, 280, 333) Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References The reader is permitted to make one copy of the information displayed for his/her own non-commercial use. The information, content and artwork provided by this website is intended for non-commercial use by the reader. Neither South Texas Health System Heart, or any of their affiliates, nor any contributors shall have any liability for the content or any errors or omissions in the information provided by this website. Remember: There is no adequate substitution for a personal consultation with your physician. Your individual health status and any required medical treatments can only be properly addressed by a professional healthcare provider of your choice. The information on this website is provided as general health guidelines and may not be applicable to your particular health condition. (UHS), a King of Prussia, PA-based company, that is one of the largest healthcare management companies in the nation. South Texas Health System® Heart is owned and operated by a subsidiary of Universal Health Services, Inc.
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