A7020 — Interface for cough stimulating device, includes all components, replacement only
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- A Standard Written Order (SWO) must be received by the supplier before claim submission for the item.
- For DMEPOS base items that require it, a signed Written Order Prior to Delivery (WOPD) must be received before delivery of the item (and must list the base item when accessories are separately billed).
- Supplier must maintain Proof of Delivery (POD) documentation and make it available to the Medicare contractor upon request.
- Medical record documentation must support the neuromuscular diagnosis (ICD-10 per LCD-related Policy Article) and clinical evidence of significant chest wall/diaphragmatic impairment with inability to clear secretions to establish medical necessity.
Key Coverage Criteria
- Beneficiary has a diagnosis of a neuromuscular disease (see LCD-related Policy Article for applicable ICD-10 codes).
- The neuromuscular condition causes significant impairment of chest wall and/or diaphragmatic movement resulting in inability to clear retained respiratory secretions.
- Flutter / Acapella Device - ICD-10 codes covered if selection criteria are met : Q89.3 Quantitative Pupillometry/Pupillography
- 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.
- Chest physiotherapy when the member’s pulmonary condition is unstable.
- Airway oscillating devices (e.g., Flutter and Acapella) as medically necessary DME to assist in mobilizing respiratory tract secretions for members with: cystic fibrosis (CF), chronic bronchitis, bronchiectasis, immotile cilia syndrome (primary ciliary dyskinesia), and asthma.
2 Active Policies
L33795 — Mechanical In-exsufflation Devices
J19
AETNA-CPB-0067 — Chest Physiotherapy and Airway Clearance Devices
Related Codes
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