Payer PolicyActive
Action
ANTHEM-MP-A050283
Anthem
Effective: May 22, 2025
Updated: December 30, 2025
Policy Summary
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.
Coverage Criteria Preview
Key requirements from the full policy
"Intrapulmonary percussive ventilation devices are consideredinvestigational and not medically necessaryfor all indications, including but not limited to the following:"
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