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Volara and Medicare

Posted by mdf @mdf, May 12, 2023

I have a friend who has been prescribed the Volara Airway Clearance device. She has been told by the company who manufacturers it that Medicare doesn't cover it, but she was under the assumption that they do based on her conversation with the prescribing doctor. Has anyone on this forum had experience with this Volara device and payment by Medicare? If so, I would appreciate so much any info you may have. Thank you in advance.

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irenea8 | @irenea8 | May 14, 2023
In reply to @scoop "@irenea8 This video helped clear up a number of questions about Volara. https://www.youtube.com/watch?v=8o9GE05PRVI Essentially, it appears..." + (show)
@scoop

@irenea8 This video helped clear up a number of questions about Volara.
https://www.youtube.com/watch?v=8o9GE05PRVI

Essentially, it appears to be a neb and automated PEP device in one. One of my questions was when do you clear/huff. That time is programmed in throughout the treatment. There's a 30 minute max time, so the user cannot go on and on. The video showed a 17 minute treatment time, so maybe that's average?

How well Volara clears in comparison with other methods was not answered. Maybe someone that has it will chime in.

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It looks a bit complicated on the video. I guess the basic idea is that it may help more than an Aerobika to loosen and clear the mucus. My first clearance session with neb followed by Aerobika lasts about an hour total but perhaps with this it would be less time. If anyone else uses this and finds it works better than flutter devices let us know!

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1 reply
nana2sandy | @nana2sandy | Jul 3, 2023
In reply to @cayenne "I have used the Volara since July 2022. My Medicare Advantage plan covered most of it...." + (show)
@cayenne

I have used the Volara since July 2022. My Medicare Advantage plan covered most of it.
It has alternating cycles of pressure which expands the airways and pulses which are kind of like an internal vest, all the while nebulizing (saline in my case). The nebulizer is weaker than my Ombra. So I use the Aerobika attached to the Ombra for morning airway clearance and the Volara in the afternoon. I was able to trial the Volara at NJH and my local pulmonologist before deciding to get it.

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Hello, I'm on medical and have a supplemental plan. My doctor at NJH wants me to use this machine, but Hill Rom wont submit it to Medicare because they say they will not approve it. How did you get yours approved?
Thanks

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1 reply
cayenne | @cayenne | Jul 3, 2023
In reply to @nana2sandy "Hello, I'm on medical and have a supplemental plan. My doctor at NJH wants me to..." + (show)
@nana2sandy

Hello, I'm on medical and have a supplemental plan. My doctor at NJH wants me to use this machine, but Hill Rom wont submit it to Medicare because they say they will not approve it. How did you get yours approved?
Thanks

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It was a year ago now, but I’m pretty sure Hill Rom submitted it. BUT, I just got a letter from my insurance co (Medicare advantage) that they have denied it for this coming year. So hill Rom is following up with NJH to submit medical records for an appeal. You might want to ask NJH about how they are getting them approved now.

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nana2sandy | @nana2sandy | Jul 3, 2023
In reply to @mdf "Thanks Sue. I don't know if this is considered a "high frequency chest oscillation device" or..." + (show)
@mdf

Thanks Sue. I don't know if this is considered a "high frequency chest oscillation device" or not, since I am not very familiar with the device but I would think for it to work on secretions it would have to be, but according to the cms.gov website if it is, if you meet one of three criterion (i.e. CF, Bronchietasis (with qualifiers), or a host of neuromuscular disease diagnoses, AND have a well documented failure of standard treatments to adequately mobilize retained secretions, it should be covered by Medicare. I may be misreading something as I am not very familiar with this sort of thing and would love it someone would set me straight on where my thinking is incorrect. I will have to say, I was surprised that it might not be covered. I am wondering now if the Smart Vest and other similar devices are covered by Medicare. Anyone know from experience?

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Medicare paid for my vest.

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wardmedicalsupplies | @wardmedicalsupplies | Sep 21, 2023

Medicare does have a code to bill for a device like this.

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1 reply
Rick | @rstel7272 | Sep 22, 2023
In reply to @irenea8 "It looks a bit complicated on the video. I guess the basic idea is that it..." + (show)
@irenea8

It looks a bit complicated on the video. I guess the basic idea is that it may help more than an Aerobika to loosen and clear the mucus. My first clearance session with neb followed by Aerobika lasts about an hour total but perhaps with this it would be less time. If anyone else uses this and finds it works better than flutter devices let us know!

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For me it does however I suffer from side effects. My first 4 months, my breathing was better but my ears suffered. The pressure affected my eustachian tubes, like swimmers ear and the albuterol getting pushed further into the lungs amplified my tachycardia to the point I stopped everything and saw a cardiologist. Got the SVT under control and went back on the volara and while breathing better, now have tinnitus in the left ear. I was on private insurance last year who surprisingly bought the machine for me.

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nana2sandy | @nana2sandy | Sep 23, 2023
In reply to @wardmedicalsupplies "Medicare does have a code to bill for a device like this." + (show)
@wardmedicalsupplies

Medicare does have a code to bill for a device like this.

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Hi, do you know what the code is? HillRom told me that they are no longer submitting the claim to medicare. Do you know the code? I can't seem to get anywhere with them other than they will finance one for me, but will not submit the claim.

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Rick | @rstel7272 | Sep 24, 2023

Is Medicare paying for the refill supplies from Hillrom? I have a volara and just went on Medicare. Hillrom sent me some forms wanting $250. I will not sign it, way too much for a simple filter.

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wardmedicalsupplies | @wardmedicalsupplies | Sep 25, 2023
In reply to @nana2sandy "Hi, do you know what the code is? HillRom told me that they are no longer..." + (show)
@nana2sandy

Hi, do you know what the code is? HillRom told me that they are no longer submitting the claim to medicare. Do you know the code? I can't seem to get anywhere with them other than they will finance one for me, but will not submit the claim.

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The HCPCS codes are: E0481 (Intrapulmonary percussive ventilation system and related accessories), and E1399 (Durable medical equipment, miscellaneous [when specified as a combination continuous positive expiratory pressure (CPEP) and continuous high frequency oscillation (CHFO) device such as the Volara System for oscillation and lung expansion (OLE) therapy]
I hope this helps.

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