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.
Prior autorization is not required for In-exsufflation devices.
In-exsufflation devices are generally covered subject to the indications listed below, and per your plan documents.
For coverage of a mechanical In-exsufflation device, the following criteria must be met:
- The member must be diagnosed with a neuromuscular disease, including, but not limited to:
- Late effects of Acute Poliomyelitis
- Spinal Muscular Atrophy (SMA) such as Werdnig-Hoffman disease
- Multiple Sclerosis
- Congenital Hereditary Muscular Dystrophy
- Hereditary Progressive Muscular Dystrophy
- Amyotrophic lateral sclerosis
- The neuromuscular disease must be causing a significant impairment of chest wall and/or diaphragmatic movement, resulting in an inability to clear retained secretions.
- Standardized treatments such as postural drainage and chest percussion have been unsuccessful in clearing retained secretions.
- A member’s initial In-exsufflation device will be rented up to the time the payments have reached the purchase price, at which time the device becomes owned by the member.
Mechanical insufflation-exsufflation devices are designed to assist cough by inflating the lung with positive pressure, followed by a rapid shift to negative pressure. These portable, electric devices are advocated for use in patients with neuromuscular diseases who have an insufficient ability to cough.
Alternate names: CoughAssistTM, In-Exsufflator, CofflatorTM and cough machine.
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.
Cough stimulating device, alternating positive and negative airway pressure
CPT Copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
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.
For in-network benefits to apply, item must be received from a contracted vendor who carries respiratory equipment. This could be a vendor who has a full line of DME equipment, or from a specialty vendor.