HFCWO and MIE Devices High Frequency Chest Wall Oscillation (HFCWO) devices are covered for beneficiaries who meet criteria 1, 2, or 3 AND 4. Critera 1
OR Critera 3
There is a diagnosis of cystic fibrosis (refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses).
The beneficiary has one of the following neuromuscular disease diagnoses (refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses):
OR Critera 2 There is a diagnosis of bronchiectasis (refer to the “ ICD-10 code list in the LCD-related Policy Article for applicable diagnoses) which has been confirmed by a high resolution, spiral, or standard CT scan and which is characterized by: Daily productive cough for at least 6 continuous months; OR Frequent (i.e., more than 2/year) exacerbations requiring antibiotic therapy. Chronic bronchitis and chronic obstructive pulmonary disease (COPD) in the absence of a confirmed diagnosis of bronchiectasis do not meet this criterion.
Post-polio Acid maltase deficiency Anterior horn cell diseases Multiple sclerosis Quadriplegia
Hereditary muscular dystrophy Myotonic disorders Other myopathies Paralysis of the diaphragm
AND Critera 4 There must be well-documented failure of standard treatments to adequately mobilize retained secretions.
Mechanical in-exsufflation devices(E0482) are covered for beneficiaries who meet all of the following criteria; Critera 1
Critera 2
They have a neuromuscular disease (refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses)
This condition is causing a significant impairment of chest wall OR/AND diaphragmatic movement, such that it results in an inability to clear retained secretions.