Ohio Admin. Code 5160-10-08 - DMEPOS: high-frequency chest wall oscillation (HFCWO) devices
(A)
Coverage.
(1)
Payment may be made for a high-frequency chest wall
oscillation (HFCWO) device on a rental/purchase basis.
(2)
The default
certificate of medical necessity (CMN) is form ODM 10229, "Certificate of
Medical Necessity: High-Frequency Chest Wall Oscillation Devices"
(7/2018).
(3)
An initial trial period of at least two months is
required. Payment may be made for rental during this trial period, excluding
any portion that coincides with an inpatient hospital stay, and a CMN must
include the following elements:
(a)
Evidence of a respiratory condition for which a HFCWO
device is an appropriate treatment, including but not limited to the following
examples:
(i)
A
diagnosis of cystic fibrosis that has not been ameliorated by any other
treatment;
(ii)
A diagnosis of another respiratory condition that
produces chronic, excessive, retained bronchopulmonary secretions;
or
(iii)
A medical history of chronic or recurrent respiratory
infections that require antibiotics and multiple hospitalizations and are
unresolved by other bronchial hygiene therapy;
(b)
If applicable,
documentation that other airway-clearance treatments are ineffective or
contraindicated;
(c)
Specification of the duration and frequency of therapy;
and
(d)
If applicable, specification of other individuals
(e.g., siblings) with whom equipment is to be shared.
(4)
If use of the
HFCWO device is to be continued in a residential setting after the initial
trial period, the CMN must be revised to include the following
information:
(a)
An attestation to the effectiveness of the device
during the trial period and every previous rental period;
(b)
If applicable,
specification of a change in the duration or frequency of therapy;
and
(c)
A recommendation either for additional rental or for
purchase.
(B)
Constraints and
limitations.
(1)
The need for a HFCWO device is not established if the
condition diagnosed is not accompanied by such symptoms of respiratory distress
as the accumulation of bronchopulmonary secretions or bronchopulmonary
infection. Common diagnoses that by themselves do not establish need include
but are not limited to the following examples:
(a)
Amyotrophic
lateral sclerosis;
(b)
Asthma, uncomplicated;
(c)
Bronchiectasis,
uncomplicated;
(d)
Cerebral palsy, any variety;
(e)
Chronic
obstructive pulmonary disease (COPD);
(f)
Chronic
respiratory failure, unspecified;
(g)
Muscular
dystrophy;
(h)
Pneumonia, uncomplicated;
(i)
Polyneuropathy;
and
(j)
Quadriplegia.
(2)
Payment for a
HFCWO device that has been dispensed on the basis of a diagnosis alone is
subject to recovery.
Notes
Promulgated Under: 119.03
Statutory Authority: 5164.02
Rule Amplifies: 5164.02
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