Navigating the reimbursement process from an insurance company can be frustrating and complicated at times. Coverage criteria and documentation requirements can vary for patient to patient, largely depending on their medical condition and their health insurance carrier and plan. All High Frequency Chest Wall Oscillation (HFCWO) airway clearance therapy vests fall under the E0483 HCPCS and require a doctor’s prescription for use.
The AffloVest also requires a doctor’s prescription for treatment by HFCWO. The AffloVest has received the FDA’s 510k clearance for U.S. market availability, and is approved for Medicare, Medicaid, and private health insurance reimbursement under the Healthcare Common Procedure Coding System(HCPCS) code E0483 – High Frequency Chest Wall Oscillation. The AffloVest is available through the U.S Department of Veterans Affairs/Tricare. Patients must qualify for coverage and meet their individual insurance’s eligibility requirements.
Private insurance carriers may or may not follow Medicare’s coverage policies and may also require prior authorization as a condition of coverage. Some may require specific documentation or may not cover all of the diagnoses in Medicare’s coverage guidelines. Most will also require that alternative, standard airway clearance therapies have been tried and failed prior to approving HFCWO therapy for coverage. It is best to contact your individual insurance carrier or have the medical equipment company you are working with contact the insurance directly to request all required documentation needed for insurance coverage.