Combination Positive Expiratory Pressure, Airway Oscillation, and Intermittent Flow

Combination Positive Expiratory Pressure, Airway Oscillation, and Intermittent Flow Acceleration Device A. The Division of Medicaid defines a combination positive expiratory pressure, airway oscillation, and intermittent flow acceleration device as a unit for mobilizing respiratory tract secretions in a beneficiary with chronic lung conditions such as, but not limited to: 1. Chronic obstructive lung disease, 2. Chronic bronchitis, 3. Cystic fibrosis, or 4. Emphysema. B. The Division of Medicaid covers this device for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity for purchase when the beneficiary has one (1) of the following diagnosis: 1. A chronic lung condition where mobilization of respiratory secretions is hindered, 2. Cystic fibrosis, 3. Bronchiectasis, 4. Chronic bronchitis/COPD, and 5. Atelectasis, or 6. Any other disease process in which secretion mobilization is needed. C. Beneficiary teaching must be documented along with the beneficiary’s ability to properly use and clean the device. D. The item may not be appropriate for children less than six (6) years of age. 1. For the item to be considered for children under age six (6), the ordering physician or allowed NPP conducting the face-to-face encounter must document that the child is able to use the device correctly. 2. Individual consideration will be given for children under age six (6).