Does A7020 require prior authorization?

No, A7020 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A7020?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`A7020`, Interface for cough stimulating device, includes all components, replacement

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) must be received by the supplier before claim submission for the item.
For DMEPOS base items that require it, a signed Written Order Prior to Delivery (WOPD) must be received before delivery of the item (and must list the base item when accessories are separately billed).

Medical record documentation must support the neuromuscular diagnosis (ICD-10 per LCD-related Policy Article) and clinical evidence of significant chest wall/diaphragmatic impairment with inability to clear secretions to establish medical necessity.

Suppliers must follow the LCD-related Standard Documentation Requirements Article, the LCD-related Policy Article, the Supplier Manual, and any DME MAC bulletins/publications referenced for additional documentation and payment rules.

For high-frequency chest compression systems: documentation of 'well-documented failure of standard treatments' to adequately mobilize retained secretions is required (i.e., evidence that standard treatments have been attempted and were inadequate).

Key Coverage Criteria

Beneficiary has a diagnosis of a neuromuscular disease (see LCD-related Policy Article for applicable ICD-10 codes).
The neuromuscular condition causes significant impairment of chest wall and/or diaphragmatic movement resulting in inability to clear retained respiratory secretions.
Flutter / Acapella Device - ICD-10 codes covered if selection criteria are met : Q89.3 Quantitative Pupillometry/Pupillography
Home chest physiotherapy upon the initial prescription of chest physiotherapy to stabilize the member and to train family members or caregivers to administer chest physiotherapy.
Chest physiotherapy when the member’s pulmonary condition is unstable.
Airway oscillating devices (e.g., Flutter and Acapella) as medically necessary DME to assist in mobilizing respiratory tract secretions for members with: cystic fibrosis (CF), chronic bronchitis, bronchiectasis, immotile cilia syndrome (primary ciliary dyskinesia), and asthma.

6 Active Policies

L33795, Mechanical In-exsufflation Devices

AETNA-CPB-0067, Chest Physiotherapy and Airway Clearance Devices

BCBSIL-DME101.027, Airway Clearance Devices

BCBSMT-DME101.027, Airway Clearance Devices

BCBSNM-DME101.027, Airway Clearance Devices

BCBSOK-DME101.027, Airway Clearance Devices

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A7020, Interface for cough stimulating device, includes all components, replacement