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Coverage criteria policies

Flutter Device

These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage.

Administrative Process

Does not require prior authorization.

Coverage

Generally covered subject to the indications listed below and following limits from your member contract:

Indications that are covered

  1. For diagnosed cystic fibrosis, immotile cilia syndrome, bronchiolitis obliterans, or bronchiectasis, or other condition that produces retained secretions.
  2. Medical documentation supports need for assistance with mucus clearance from airway daily.

Definitions

The flutter device is a hand held unit, which helps to clear mucus from the lungs. The flutter device is used for chronic illnesses, such as Cystic Fibrosis, in which the lungs produce excessive mucus. Exhaling through the flutter device vibrates the airway walls and loosens mucus. The member is able to cough up the mucus. The Acapella Device is an example of a flutter device.

If available, codes are listed below for informational purposes only, and do not guarantee member coverage or provider reimbursement. The list may not be all-inclusive.

Codes

Description

E0484

Oscillatory positive expiratory pressure device, nonelectric, any type, each

CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Products

This information is for most, but not all, HealthPartners plans. Please read your plan documents to see if your plan has limits or will not cover some items. If there is a difference between this general information and your plan documents, your plan documents will be used to determine your coverage. These coverage criteria may not apply to Medicare Products if Medicare requires different coverage. For more information regarding Medicare coverage criteria or for a copy of a Medicare coverage policy contact Member Services at 952-883-7979 or 1-800-233-9645.

Vendor - Full Line

  • Items must be received from a contracted vendor who carries a full line of DME equipment.
  • Full line vendors provide a wide range of equipment and supplies, such as hospital beds, aids for ambulating and toileting, phototherapy lights, wheelchairs, custom seating devices, monitors, pumps, oxygen and etc.

Go to

Policy activity

  • 01/01/1998 - Date of origin
  • 01/01/1998 - Effective date
Review date
  • 04/2015

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