Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines

Aetna covers incentive spirometers as DME only for postoperative use in members with neuromuscular or chest wall diseases, intermittent positive pressure breathing (IPPB) machines for asthma, COPD and other respiratory diseases (and a fluidic breathing assistor when IPPB is used for nebulization), with CPT 94640 and HCPCS E0487 payable only when documented selection criteria/medical necessity are met. The SpiroTimer and incentive spirometers for all other indications are considered experimental/investigational and excluded (examples: oromotor/pulmonary therapy in Down syndrome, pre-op use for bariatric surgery, prevention of atelectasis after laparotomy/upper‑abdominal surgery/neurosurgery/CABG, and treatment of acute chest syndrome in sickle cell disease).

"CPT 94640 (Pressurized or nonpressurized inhalation treatment ."

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