Peak flow meters are eligible durable medical equipment when used for patients with obstructive airway disease, such as asthma (493.00-493.92), with a reversible component, e.g., after medications change, after activities, in suspect environments, such as at work, and to signal the onset of exacerbation of their condition. Use of the peak flow meter is also indicated for patients with chronic obstructive pulmonary disease (COPD), (490, 491.0-491.1, 491.20-491.22, 491.8-491.9, 492.0-492.8, 494.0-494.1, 495.0-495.9, 496). Peak flow meters provided for indications other than those referenced should be denied as not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service.

Many versions of the peak flow meter are available. While all measure the PEFR, some are computerized or offer central data bank transmitting/storing of information recorded in the diary of a standard device. These "deluxe" versions are not significantly more reliable than the hand-held units. Therefore, a deluxe device is eligible only when the patient's inability to use a standard device can be established. In these instances, the deluxe device should be the most appropriate one that can be safely provided to the patient.

NOTE:

Total payments for a rental item may not exceed its allowable purchase price, except for those items identified as life sustaining DME. For information on continuous rental of life sustaining DME, see Medical Policy Bulletin E-38, Continuous Rental of Life Sustaining Durable Medical Equipment (DME).

Coverage for DME is determined according to individual or group customer benefits.

Description

A peak flow meter (A4614, S8096) is a simple portable device designed to measure the peak expiratory flow rate (PEFR) that occurs when a forced maximum exhalation is carried out from total lung capacity. The hand-held device is designed for patient use in the home and is a reasonably reliable tool for patient monitoring of their own airway function.

To use the device, the gauge, which measures the PEFR, is set at zero and the user then exhales into the mouthpiece. The PEFR measurement is displayed on the gauge, and the patient then records the measurement in the diary provided with the device.

The peak flow meter requires the coordination necessary to operate the device and the ability to understand instruction on its use. The patient is educated on the use of the device including when and how often it should be used, the importance of the diary, and their response to the monitoring, such as disease management.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.