CSHCN 2009 > Respiratory Equipment and Supplies > Benefits, Limitations, and Authorization Requirements

32.2.6 High Frequency Chest Wall Compression System (HFCWCS)

Providers must use procedure code E0483 when billing for HFCWCS.

Prior authorization is required for HFCWCS. A completed CSHCN Services Program Prior Authorization Request for Chest Physiotherapy Devices must be submitted with documentation of medical necessity.

Prior authorization for the purchase of HFCWCS may be considered for clients with the following diagnosis codes. Other diagnoses will be considered with documentation of medical necessity.

Documentation of medical necessity must include:

•An explanation of why other modes of chest physiotherapy have not been effective for the client. Include information about other modes used with the client.

•Results of pulmonary function tests (PFTs) done in the last 6 months.

•Hospitalizations or infections that required intravenous (IV) antibiotics in the last 6 months.

•Work or school absences over the last 6 months because of problems related to the respiratory condition.

•Whether the client has discontinued sports or other extracurricular activities because of fatigue related to a respiratory condition.

If documentation supports the need for an HFCWCS, a 3-month rental trial may be approved. If the HFCWCS is documented to be effective at the end of the initial 3-month rental period, purchase of the system may be authorized. If at the end of the initial 3-month rental period a determination of purchase cannot be made, an additional 3-month rental may be given.

At the end of the 3-month trial, the following information should be sent with the request to purchase the generator for the client:

•PFT results from the final month of rental

•Evidence of clinical improvement, other than PFTs, including improved work or school attendance or the ability to participate in extracurricular activities

•The frequency and compliance graphs that were generated by the compressor for the 6-month period and that indicate compliance with the physician's prescription

Providers must document the information on the form located in Appendix B, "CSHCN Services Program Prior Authorization Request for Chest Physiotherapy Devices".

The rental fees for these systems are applied to the purchase price of the compressor; therefore, a new compressor is provided at the onset of the rental period.

An HFCWCS is a once-in-a-lifetime purchase because the manufacturer provides a lifetime warranty.

Replacement of the HFCWCS vest may be considered, if documentation indicates that the client has outgrown the vest.

An HFCWCS is not purchased or rented if the CSHCN Services Program is currently renting a cough stimulating device for the client.