How to Simplify Your Reimbursement Process for the AffloVest

Published in Member Communities on April 01, 2026

By Kathy Boland, CDME, LPN, Payer Relations Manager, Tactile Medical

Navigating reimbursement requirements for airway clearance therapies can be complex, especially when working across a wide range of diagnoses and payer policies. To support clinicians, care teams, and payer partners, Tactile Medical has streamlined the process for determining medical necessity and documentation standards for the AffloVest. With nearly 80 ICD-10 codes now qualifying for coverage, it is easier than ever to identify appropriate candidates and ensure supporting documentation aligns with payer expectations. The following guidance outlines the diagnostic categories, clinical indicators, and best practice documentation needed to facilitate accurate, efficient reimbursement and help patients access the therapy they need.

Qualification for Patients for the AffloVest

It depends on what diagnosis or clinical manifestations that are specific to the patient and qualifying diagnosis.

With clinical evaluation in all patients, we should consider the symptoms that describe why a patient may need airway clearance therapy, such as the AffloVest.

Symptoms to Consider:

Chronic cough
Mucus retention, mucus plugging
Frequent lung infections and pneumonia with antibiotic and/or steroid intervention
Weak, ineffective cough that does not offer the ability to clear secretions
Increased work of breathing with use of accessory muscles
Aspiration, dysphagia

Bronchiectasis is the only diagnosis that has specific criteria, which includes:

Diagnostic testing: CT of chest scan with interpretation supporting diagnosis.
Documentation of number of lung infections or hospital admissions >2 in the past year requiring antibiotic intervention.
OR
Documentation of chronic daily productive cough > 6 months. Describe the nature, frequency, and onset of patient cough.
Documentation of tried and failed standard airway clearance therapy and outcomes, such as failed to mobilize retained secretions.
Best practice is noting dates and specific antibiotic interventions.

All other ICD-10 diagnosis codes require the following:

NO diagnostic testing is required for these diagnosis categories

The criteria include:

Covered diagnosis
Chart notes need to support the diagnosis and medical necessity within 6 months
Well-documented failure of other treatments to adequately mobilize retained secretions

The diagnosis must be clearly defined within the encounter or face-to-face notes and be part of the patient’s clinical diagnostic history. It is important that the diagnostic history clearly paints a picture of how the patient’s condition has evolved and has compromised their ability to clear secretions on their own.

Additionally, there must be information in the beneficiary’s medical record that describes in detail the underlying medical conditions that cause the accumulation of pulmonary secretions, the treatment interventions (for example, chest physiotherapy, PEP, postural drainage, medications used), and the effectiveness of the treatment.

What does tried and failed look like, and how did this fail to mobilize retained secretions?

Did not mobilize secretions
Unable to tolerate positioning (CPT)
Insufficient expiratory force (PEP)
Physical limitations of patient or caregiver
Cognitive level
Severe arthritis/osteoporosis

Best Practice Checklist for Coverage in Review

Chart notes (within 6 months) specific to patient condition, diagnosis, cough, recurrent lung infections with dates and antibiotic interventions, if applicable to diagnosis.
The approved diagnosis (written out or ICD-10 code) must be in chart notes and not just on prescription.
A clear picture must be painted in the chart notes of how the patient's disease has progressed to airway clearance issues, especially in disorders of the diaphragm, neuromuscular conditions, and myopathy. (Be specific, as each patient’s disease process is individual.)
Documentation should concentrate on the evaluation of the covered diagnosis.
Documentation must show that specific standard airway clearance therapy techniques or device was tried and failed to mobilize retained secretions or is not appropriate for a patient and will not be sufficient to resolve symptoms. Best practice statement: “Failed to mobilize secretions” or why it is “ineffective” or “unable to perform.”
Commercial plans may have exceptions for medical necessity on additional diagnosis depending on payer and plan.
E0483 (after setup) is progress notes documenting the benefit of use and continued need prior to CAP to purchase.

Reminder

E0483 falls under RUL for replacement
E0482, E0483, and E0469 fall under same and similar

Tactile Medical is here for you. Please contact us at afflovestinfo@tactilemedical.com or your local AffloVest representative for ongoing help and support.

TAGS