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Mechanical percussors (e.g., Fluid Flo, Frequencer, and VibraLung Acoustical Percussor) for CF, chronic bronchitis, bronchiectasis, immotile cilia syndrome, and asthma.Airway oscillating devices (e.g., Flutter and Acapella) for cystic fibrosis (CF), chronic bronchitis, bronchiectasis, immotile cilia syndrome (also known as primary ciliary dyskinesia) and asthma.Note: Chest physiotherapy by a respiratory therapist is not considered medically necessary for persons whose pulmonary condition is stable, as chest physiotherapy can be competently administered at home by a family member or caregiver.Īetna considers the following airway clearance devices medically necessary durable medical equipment (DME) to assist in mobilizing respiratory tract secretions for members with the conditions that are indicated below: Chest physiotherapy when the member’s pulmonary condition is unstable.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.This Clinical Policy Bulletin addresses chest physiotherapy and airway clearance devices.Īetna considers the folowing interventions by a respiratory therapist medically necessary: (Replaces CPBs 252, 280, 333) Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References