Provider Alert! Secretion and Mucous Clearance Device Update on rental optionTexas Children's Health Plan
Date: December 17, 2021
Attention: Pulmonologists and DME providers
Effective Date: June 1, 2020 for Intrapulmonary Percussive Ventilation (IPV) rental information
Call to action: update for December 17, 2021: Intrapulmonary Percussive Ventilation (IPV)*: effective June 1, 2020, this device is available for rent only and no longer has the rent to purchase option.
Secretion and mucous clearance devices will require prior authorization except for percussion cups. Here is the link to the Prior Authorization Form:
Information on coding for devices:
|Intrapulmonary Percussive Ventilation (IPV)*||E0481. TCHP will no longer accept E1399. This is not a current benefit of Texas Medicaid and will be reviewed by the TCHP Medical Director on a case- by-case basis.|
|Percussion cup||E1399 purchase only. Does not require a Prior Authorization.|
|Electrical percussors||E0480 Considered purchase after 10-month max rental|
|Cough augmentation devices (cough assist machine, mechanical insufflator-exsufflator) gives positive and negative pressure to the airway, stimulating natural cough.||E0482 rental only|
|High-frequency Chest Wall Oscillation (HFCWO) System*||E0483|
*Intrapulmonary Percussive Ventilation (IPV)*: effective June 1, 2020, this device is available for rent only and no longer has the rent to purchase option.
The medical necessity criteria is available in the prior authorization guidelines available here:
How this impacts providers: Providers will be reimbursed for Intrapulmonary Percussive Ventilation procedures at a default percent of billed charges when billing with code E0481 and should follow the additional coding information posted above. TCHP will reprocess affected claims submitted with the procedure code and date of service on or before June 1, 2020. Providers are not required to appeal the claims unless they are denied for additional reasons after the claims reprocessing is complete.
Next steps for providers: Providers should coordinate this change with their billing staff.
If you have any questions, please email Provider Network Management at: firstname.lastname@example.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
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