Airway Clearance Devices (for Kansas Only)
Policy governing coverage and medical necessity guidance for airway clearance devices (including high-frequency chest wall oscillation and intrapulmonary percussive ventilation systems) for members in Kansas.
Added language to indicate combination continuous positive expiratory pressure, continuous high-frequency oscillation, and nebulized medication therapy devices for oscillation and lung expansion are considered unproven and not medically necessary.
Medical records documentation language was added clarifying documentation may be required to assess clinical criteria and must support medical necessity.
Applicable HCPCS and ICD-10 codes were added (examples: HCPCS A7021, E0469 and multiple ICD-10 codes).
Updated Description of Services and References sections; archived previous policy version CS054KS.02.
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