Respiratory System
Durable Medical Equipment (DME) (including Wearable Defibrillators)

Diagnosis: Chronic Obstructive Lung Disease/COPD
Treatment: High-frequency chest wall oscillatory (HFCWO)

The health plan denied: High-frequency chest wall oscillatory (HFCWO)
The determination is: Upheld

The patient is a female with a medical history of right middle lobe, right upper lobe, and lingula focal bronchiectasis with a chronic cough and mucus production. Per the medical information provided, she has tried manual chest physiotherapy for airway clearance. The attending physician is requesting a high frequency chest wall oscillation system (HFCWO) for airway clearance.
At issue is the medical necessity of the HFCWO.
The health plan's determination of medical necessity is upheld in whole.
The requested health service/treatment of Durable Medical Equipment - High-frequency chest wall oscillatory (HFCWO) is not medically necessary for this patient.
This device works via delivery of an intermittent flow of air into a jacket, which rapidly compresses and releases the chest wall at a variety of frequencies. The oscillation in airflow within the airways has been shown to augment central and peripheral mucus clearance. Most available HFCWO systems are Food and Drug Administration (FDA) approved for airway clearance to improve bronchial drainage. The prescriber is requesting the HFCWO for a patient with focal bronchiectasis in the right middle lobe, right upper lobe, and lingula.
HFCWO has been shown to be effective in patients with cystic fibrosis (CF). However, therapies shown to be effective in CF are often provided to patients with diffuse bronchiectasis without definitive evidence of benefit. The goals of bronchiectasis treatments are to reduce the number of exacerbations and infections and to improve patient quality of life by reducing airway inflammation and mobilizing secretions. In recent years, there has been increased interest in validating therapies for patients with bronchiectasis from cystic fibrosis. Most recently HFCWO was evaluated for non-cystic fibrosis diffuse bronchiectasis, and it was found that HFCWO provides an improvement both in pulmonary function and quality of life related parameters in patients with bronchiectasis with increased secretions. However, studies are needed to establish the effectiveness of the different airway clearance devices and techniques for long-term home use. In addition, the patient does not have a documented failure of standard treatments to adequately mobilize retained secretions (for example, Acapella valve, positive expiratory pressure [PEP] valve). Therefore, without a diagnosis of diffuse bronchiectasis and trying, failing, or having a contraindication to alternative clearance therapies, the requested health service/treatment of Durable Medical Equipment - High-frequency chest wall oscillatory (HFCWO) is not medically necessary for this patient.