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How to Prescribe AffloVest

The AffloVest requires a valid prescription for treatment by HFCWO. Once your healthcare team has decided AffloVest is the airway clearance therapy for you, they can fill out the AffloVest Order form, provide all necessary insurance and medical documentation, and contact a DME distributor to place the AffloVest order.

The AffloVest is cleared by the FDA 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.

Coverage criteria and documentation requirements can vary from patient to patient, largely depending on their medical condition and their health insurance carrier and plan.

If the primary diagnosis is bronchiectasis, signs and symptoms of one of the following must be met:

  • Daily productive (mucus) cough for at least 6 continuous months in the year prior to the date of the order, OR
  • Frequent (i.e. more than two a year) exacerbations/chest infections (such as pneumonia) requiring antibiotic therapy in the year prior to the date of the order
  • HRCT scan confirming diagnosis

If cystic fibrosis or an approved neuromuscular diagnosis is primary, chart notes to support the diagnosis are required. Learn more about reimbursement coverage for AffloVest here.

Order Form

Use this simple Medicare checklist to determine whether your patients meet the guidelines for Medicare, Medicaid, and private insurance reimbursement. Use the prescription form on the back to place an AffloVest order.


Fax Cover Sheet

Use this Fax Cover Sheet when submitting orders to AffloVest to ensure all patient and order information is submitted correctly and in a timely manner.