E0605, Vaporizer, room type
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Document absence of contraindications prior to IPPB (e.g., untreated tension pneumothorax).
- No explicit 'Documentation Requirements' section is provided in the CPB. However the policy repeatedly states coverage is contingent on meeting unspecified 'selection criteria' (e.g., CPT and HCPCS codes 'covered if selection criteria are met') — documentation should therefore demonstrate that the member meets the selection criteria for coverage (diagnosis and medical necessity).
- For incentive spirometers: documentation should include evidence of post-operative status and presence of neuromuscular or chest wall disease when claiming DME incentive spirometer coverage (policy: 'Incentive spirometers as durable medical equipment (DME) for post-operative use for members with neuromuscular or chest wall diseases;').
Key Coverage Criteria
- CPT 94640 (Pressurized or nonpressurized inhalation treatment ... or intermittent positive pressure breathing (IPPB) device) — covered if selection criteria are met.
- HCPCS E0487 (Spirometer, electronic, includes all accessories) — covered if selection criteria are met.
- A fluidic breathing assistor as DME when IPPB is used for nebulization or aerosolization.
- HCPCS E0500 (IPPB machine, all types, with built-in nebulization; manual or automatic valves; internal or external power source) — covered if selection criteria are met.
- Incentive spirometers as durable medical equipment (DME) for post-operative use for members with neuromuscular or chest wall diseases;
- Intermittent positive pressure breathing (IPPB) machines as DME for members with asthma, chronic obstructive pulmonary disease (COPD) and other respiratory diseases;
6 Active Policies
AETNA-CPB-0479, Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines
DME101.000, DME Introduction
BCBSIL-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSMT-DME101.000, Durable Medical Equipment (DME) Reference List
BCBSNM-DME101.000, Durable Medical Equipment (DME) Reference List
Related Codes
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