Medicare Coverage Criteria for Vest Therapies

Bronchiectasis

Patient diagnosed with bronchiectasis:

Confirmed by a standard CT scan, which is characterized by:

a) Daily productive cough for at least six continuous months;

OR

b) Frequent (i.e. three or more in a year) exacerbations requiring antibiotic therapy;

AND

There must be well-documented failure of standard treatments to adequately mobilize retained secretions.

Examples of standard treatments

  • Manual Chest Percussion Therapy (CPT)
  • Postural drainage
  • Positive Expiratory Pressure (PEP) device

Nebulized medication with mucolytic

Reimbursement services

Many airway clearance systems prescribed for specific diagnoses, including BE, are approved for payment by more than 1,500 commercial insurance companies and government-funded payers annually.

The insurance submission process can be complex and time-consuming. Ask your airway clearance therapy (ACT) device manufacturer if they will work with your insurer to:

  • Assemble and submit required paperwork
  • Answer questions
  • Coordinate appeals

In the event that you do not have the financial resources to pay for what insurance does not cover, ask the manufacturer about assistance programs and payment plan options.

Reimbursement

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206963 rev 1 25-OCT-2017 ENG – US