OAR 410-122-0211
Cough Stimulating Device
(1)
Indications and Limitations of Coverage and Medical Appropriateness: The Division of Medical Assistance Programs (Division) may cover a cough stimulating device, alternating positive and negative airway pressure for a client who meets the following criteria:(a)
The client has been diagnosed with a neuromuscular disease as identified by one of the following diagnosis codes:(A)
Late effects of acute poliomyelitis;(B)
Cystic fibrosis;(C)
Werdnig-Hoffmann disease—anterior horn cell disease unspecified;(D)
Multiple sclerosis — quadriplegia and quadriparesis;(E)
Myoneural disorders;(F)
Disorders of diaphragm;(G)
Fracture of vertebral column, cervical, or dorsal (thoracic);(H)
Late effect of spinal cord injury;(I)
Late effect of injury to a nerve root or roots, spinal plexus or plexuses and other nerves of trunk;(J)
Spinal cord injury without evidence of spinal bone injury, cervical or dorsal (thoracic); and(b)
Standard treatment such as chest physiotherapy (e.g., chest percussion and postural drainage, etc.) has been tried and documentation supports why these modalities were not successful in adequately mobilizing retained secretions; or(c)
Standard treatment such as chest physiotherapy (e.g., chest percussion and postural drainage, etc.) is contraindicated and documentation supports why these modalities were ruled out; and(d)
The condition is causing a significant impairment of chest wall or diaphragmatic movement, such that it results in an inability to clear retained secretions.(2)
Procedure Code:(a)
E0482 (cough stimulating device, alternating positive and negative airway pressure)—prior authorization required;(b)
The Division will purchase or rent on a monthly basis (limited to the lowest cost alternative);(c)
E0482 is considered purchased after no more than ten months of rent;(d)
E0482 may be covered for a client residing in a nursing facility;(e)
The fee includes all equipment, supplies, services, routine maintenance, and necessary training for the effective use of the device.(3)
Documentation Requirements: Submit specific documentation from the treating practitioner that supports coverage criteria in this rule are met and may include, but is not limited to, evidence of any of the following:(a)
Poor, ineffective cough;(b)
Compromised respiratory muscles from muscular dystrophies or scoliosis;(c)
Diaphragmatic paralysis;(d)
Frequent hospitalizations or emergency department/urgent care visits due to pneumonias.
Source:
Rule 410-122-0211 — Cough Stimulating Device, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-122-0211.