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This policy addresses intrapulmonary percussive ventilation (IPV) devices used to facilitate airway clearance. Anthem deems IPV investigational/experimental and not medically necessary; therefore, it is not covered for any indication. Noncoverage applies across all settings and includes, but is not limited to, cystic fibrosis, bronchiectasis, COPD, and neuromuscular conditions with retained secretions or atelectasis; related codes (A7021, E0469, E0481, S8200, S8205) may be denied.

"Intrapulmonary percussive ventilation devices are consideredinvestigational and not medically necessaryfor all indications, including but not limited to the following:"

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