Airway Clearance Devices

Revised: December 17, 2025

· Overview

· Eligible Providers

· TPL and Medicare

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization

· Billing

Overview

Airway clearance devices provide self-administered airway clearance for people with certain respiratory or neuromuscular conditions.

Eligible Providers

The following providers may provide airway clearance devices:

· Federally qualified health centers

· Home health agencies

· Indian Health Services

· Medical suppliers

· Pharmacies

· Rural health clinics

TPL and Medicare
Providers must meet any provider criteria, including accreditation, for third-party insurance or for Medicare to assist members for whom Minnesota Health Care Programs (MHCP) is not the primary payer.

MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested.

Refer to the Medicare and Other Insurance section of the MHCP Provider Manual for more information.

Eligible Members

Airway clearance devices are covered for eligible medical assistance or MinnesotaCare members who meet coverage criteria described under Covered Services.

Covered Services

Codes: A7020, A7025, A7026, E0480, E0482-E0484

MHCP covers the following devices:

· Electric or pneumatic percussors (E0480)

· Cough-stimulating devices (E0482) and replacement interfaces (A7020)

· High-frequency chest wall oscillation air-pulse generator systems (E0483) and replacement vests and hoses (A7025 and A7026)

· Oscillatory positive expiratory pressure devices (E0484)

Nonelectric oscillatory devices (E0484) are covered for members with medical conditions that cause a need for assistance with mucus clearance from the airway.

Electric or pneumatic percussors (E0480) are covered for members who require chest physiotherapy with the assistance of a mechanical device.

Cough-stimulating devices (E0482), also known as in-exsufflation devices, are covered with authorization for members with neuromuscular disease, which causes a significant impairment of chest wall or diaphragmatic movement, and which results in an inability to clear secretions when standard treatments have failed or are medically contraindicated. A detachable battery and a car charger for a cough-stimulating device is covered for treatment required more than three times daily.

High-frequency chest wall oscillation (HFCWO) systems (E0483) are covered with authorization for members when standard chest physiotherapy has failed or is medically contraindicated and the member has one of the following indications:

· Cystic fibrosis

· Chronic bronchiectasis, confirmed by radiological scan, and one of the following:

· Daily productive cough for at least six continuous months

· More than two exacerbations in 12 months requiring antibiotic treatment

· One of the following neuromuscular disease diagnoses:

· Acid maltase deficiency

· Anterior horn cell diseases

· Hereditary muscular dystrophy

· Multiple sclerosis

· Myotonic disorders

· Other myopathies

· Paralysis of the diaphragm

· Post polio

· Quadriplegia

Replacements parts, including HFCWO vests (A7025) and hoses (A7026) and interfaces for cough-stimulation devices (A7020), are covered for use with member-owned systems when the original part is lost, stolen or damaged beyond repair and not covered by a warranty. Authorization is required for HFCWO vest replacements.

Noncovered Services

MHCP does not cover the following devices for any indication because they are not standard in community care and substantive research is lacking:

· Intrapulmonary percussive ventilation devices (E0481)

· Lung expansion airway clearance devices (E0469)

Authorization

Authorization is required for the following:

· Cough-stimulating devices (E0482)

· Detachable battery and car charger for a cough-stimulating device

· HFCWO systems (E0483)

· Replacement HFCWO vests (A7025) for member-owned systems

Submit authorization requests and required documentation to the Medical Review Agent.

Cough-stimulating devices
Documentation must include a diagnosis of neuromuscular disease such as multiple sclerosis, spinal muscular atrophy, quadriplegia or muscular dystrophy, and the member’s history of conservative treatment and the reason it is not meeting the member’s needs or is medically contraindicated. Submit chart documentation.

HFCWO systems
Documentation must include the member’s diagnosis, history of respiratory infections, and history of chest physiotherapy, including the reason it is not meeting the member’s needs or is medically contraindicated. Submit chart documentation; a checklist is not sufficient to establish medical need.

Billing

Providers are responsible to coordinate services. Refer to the Billing Policy Overview section of the MHCP Provider Manual for general billing information.

Bill airway clearance devices using MN–ITS 837P Professional. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics, Orthotics, and Augmentative Devices MN–ITS user manual for general billing requirements and guidance when submitting claims.

· An HFCWO air-pulse generator system with full anterior or posterior thoracic region receiving simultaneous external oscillation, includes all accessories and supplies, each. Do not bill separately.

· A cough-stimulating device includes all necessary accessories with initial dispensing. Do not bill separately.

· Report the ordering provider in the Other Provider Types section of the MN–ITS Interactive claim.

· If the member has Medicare, MHCP will pay only the deductible and coinsurance on any item for which Medicare made payment, regardless of any MHCP prior authorization.

· If the member has Medicare, any items for which Medicare denies payment must meet MHCP coverage and authorization requirements.

· Shipping and delivery costs are included in the MHCP maximum allowable payment and may not be separately billed to MHCP or the member.

· Durable medical equipment is expected to serve the member for at least five years. If a device is stolen or damaged beyond repair, a replacement device may be covered with authorization.

Refer to Non-Mobility Equipment Repairs for billing requirements for repairs to durable medical equipment.