Does A7026 require prior authorization?

No, A7026 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for A7026?

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

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`A7026`, High frequency chest wall oscillation system hose, replacement for use with

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 communicated to the supplier before a claim is submitted; for items requiring Written Order Prior to Delivery (WOPD), a signed SWO/WOPD must be received before delivering the DMEPOS item.
For DMEPOS base items that require a WOPD and have separately billed options/accessories/supplies, the WOPD must list the base item (and may list associated items) prior to delivery; separate billing without a completed and signed WOPD will be denied.

Claims must meet coding guidelines in CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, and DME MAC articles; refer to the LCD-related Standard Documentation Requirements Article and LCD-related Policy Article and the Supplier Manual for additional documentation details.

Key Coverage Criteria

HFCWO device (HCPCS E0483) is covered only when the beneficiary meets at least one qualifying diagnosis (cystic fibrosis, confirmed bronchiectasis, or a listed neuromuscular disease) AND there is well-documented failure of standard treatments to adequately mobilize retained secretions.
Diagnosis of cystic fibrosis (see LCD-related Policy Article for applicable ICD-10 codes).
Diagnosis of bronchiectasis confirmed by high-resolution, spiral, or standard CT scan and characterized by either daily productive cough for at least 6 continuous months or more than 2 exacerbations per year requiring antibiotic therapy.
Beneficiary has one of the listed neuromuscular disease diagnoses: post-polio, acid maltase deficiency, anterior horn cell diseases, multiple sclerosis, quadriplegia, hereditary muscular dystrophy, myotonic disorders, other myopathies, or paralysis of the diaphragm (see LCD-related Policy Article for applicable ICD-10 codes).
There must be well-documented failure of standard airway clearance treatments to adequately mobilize retained secretions prior to HFCWO coverage.
High-frequency chest wall oscillation (HFCWO) system rental for 2 months is medically necessary for management of neuromuscular diseases, bronchiectasis, and cystic fibrosis when criteria are met.

9 Active Policies

L33785, High Frequency Chest Wall Oscillation Devices

UHC-POL-airway-clearance-devices, Airway Clearance 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

UMR-POL-UMR-airway-clearance-devices, Airway Clearance Devices

SUREST-POL-SUREST-airway-clearance-devices, Airway Clearance Devices

`A7026`, High frequency chest wall oscillation system hose, replacement for use with

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

A7026, High frequency chest wall oscillation system hose, replacement for use with

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`A7026`, High frequency chest wall oscillation system hose, replacement for use with