A7026, High frequency chest wall oscillation system hose, replacement for use with
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 communicated to the supplier before a claim is submitted; for items requiring Written Order Prior to Delivery (WOPD), a signed SWO/WOPD must be received before delivering the DMEPOS item.
- For DMEPOS base items that require a WOPD and have separately billed options/accessories/supplies, the WOPD must list the base item (and may list associated items) prior to delivery; separate billing without a completed and signed WOPD will be denied.
- Suppliers must maintain proof of delivery (POD) documentation in their files and make POD available to the Medicare contractor upon request.
- Claims must meet coding guidelines in CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, and DME MAC articles; refer to the LCD-related Standard Documentation Requirements Article and LCD-related Policy Article and the Supplier Manual for additional documentation details.
Key Coverage Criteria
- HFCWO device (HCPCS E0483) is covered only when the beneficiary meets at least one qualifying diagnosis (cystic fibrosis, confirmed bronchiectasis, or a listed neuromuscular disease) AND there is well-documented failure of standard treatments to adequately mobilize retained secretions.
- Diagnosis of cystic fibrosis (see LCD-related Policy Article for applicable ICD-10 codes).
- Diagnosis of bronchiectasis confirmed by high-resolution, spiral, or standard CT scan and characterized by either daily productive cough for at least 6 continuous months or more than 2 exacerbations per year requiring antibiotic therapy.
- Beneficiary has one of the listed neuromuscular disease diagnoses: post-polio, acid maltase deficiency, anterior horn cell diseases, multiple sclerosis, quadriplegia, hereditary muscular dystrophy, myotonic disorders, other myopathies, or paralysis of the diaphragm (see LCD-related Policy Article for applicable ICD-10 codes).
- There must be well-documented failure of standard airway clearance treatments to adequately mobilize retained secretions prior to HFCWO coverage.
- High-frequency chest wall oscillation (HFCWO) system rental for 2 months is medically necessary for management of neuromuscular diseases, bronchiectasis, and cystic fibrosis when criteria are met.
9 Active Policies
L33785, High Frequency Chest Wall Oscillation Devices
UHC-POL-airway-clearance-devices, Airway Clearance Devices
AETNA-CPB-0067, Chest Physiotherapy and Airway Clearance Devices
BCBSIL-DME101.027, Airway Clearance Devices
BCBSMT-DME101.027, Airway Clearance Devices
Related Codes
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