HFCWO | SmartVest® Airway Clearance System | Insurance Reimbursement | Medicare

Medicare Expands HFCWO Coverage for Neuromuscular Disorders

Reimbursement Services

The SmartVest® Airway Clearance System is reimbursed by Medicare, Medicaid, and private insurers. Health care insurance submission procedures can be difficult to navigate and time-intensive for all parties involved. In an effort to make this simpler for everyone, Electromed, Inc. has dedicated an entire team of reimbursement specialists to making this process as quick and easy as possible.

According to reports in the medical literature, patients with compromised airway clearance mechanisms can experience recurrent lung infections leading to pneumonia and permanent lung scarring, decreased pulmonary function, increased health care costs related to antibiotics and hospitalizations, loss of productivity, and, in some cases, morbidity and mortality(1,2).

Recognition of this potential downward health spiral has led federal, state and private payors to cover High Frequency Chest Wall Oscillation (HFCWO) for these patients. HFCWO now has an assigned HCPCS code.

High Frequency Chest Wall Oscillation has been approved by over 200 government payors and several hundred commercial payors. Coverage is not disease specific, but is based on evidence of retained pulmonary secretions and problems with mucus mobilization.

When Electromed, Inc.’s reimbursement staff receives a referral for the SmartVest® Airway Clearance System, you, the insurance provider, will be contacted to verify benefits and supply information required to attain a Prior Authorization. Included in the information will be details of the patient’s medical status from our unique Certificate of Medical Necessity and Prescription (CMN/Rx) form. This “check-off” format with additional physician notes will allow your case managers, utilization review specialists, and medical directors to very quickly assess the medical necessity for each referred patient. Our dedicated reimbursement team works interactively with your department to provide the most appropriate service to you, the patients, and their physicians.

Neuromuscular Case for Reimbursement

For further information, contact the Electromed, Inc. Reimbursement team at 800-462-1045.

1- Ohnsorg F. A Cost Analysis of High-Frequency Chest Wall Oscillation in Cystic Fibrosis. AM J Respir and Crit Care Med 1994; 149(4): A669.
2 - Plioplys AV, Lewis S, Kasnicka I. Pulmonary vest therapy in pediatric long-term care. Journal of the American Medical Director’s Association 2002 Sep-Oct; 3 (5): 318-321.