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TRICARE Policy Manual 6010.60-M, April 1, 2015
Other Services
Chapter 8
Section 16.1
Mucus Clearance Devices
Issue Date:  June 5, 1995
Authority:  32 CFR 199.4
Revision:  C-1, March 10, 2017
1.0  HCPCS PROCEDURE CODES
A7025, A7026, E0480 - E0484, S8185
2.0  DESCRIPTION
2.1  Mucus clearance devices are designed to clear mucus secretions from the lungs of patients with mucociliary clearance impairment.
2.2  Some mucus clearance devices resemble a combination of a smoker’s pipe and a referee’s whistle. It consists of a hardened plastic mouthpiece at one end, a plastic perforated cover at the opposite end, and a valve on the inside created by a high-density stainless steel ball resting in a plastic circular cone.
2.3  Other bronchial drainage systems include an air oscillator and an inflatable vest and uses high-frequency chest wall oscillations, which also clear mucus from the airway wall. This type of system is a mechanical form of Chest Physical Therapy (CPT) used as an alternative to conventional CPT in patients with Cystic Fibrosis (CF).
3.0  POLICY
3.1  Mucus clearance devices may be cost-shared for beneficiaries with mucus producing lung diseases, including, but not limited to CF and Chronic Obstructive Pulmonary Disease (COPD) (which encompasses both chronic bronchitis and emphysema), and for beneficiaries with secretory impairment that requires mucus clearance.
3.2  The mucus clearance device used must be U.S. Food and Drug Administration (FDA) approved. Coverage can only begin effective the date of FDA approval.
3.3  Intrapulmonary Percussive Ventilation (IPV) (Healthcare Common Procedure Coding System (HCPCS) code E0481) may be considered for cost-sharing when the diagnosis is CF.
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