MedicaidCoverageMedium impact
Multi-Function Oscillation Lung Expansion Therapy - MEDICAID - VIRGINIA (Revised)
Humana·VA · Pulmonology, Critical Care, Pediatrics·Medicaid
Effective date
Jul 22, 2026
We identified it
Jul 21, 2026
Summary
Humana Medicaid Virginia has clarified that Multi-Function Oscillation Lung Expansion (OLE) therapy devices, including BiWaze Clear System and Volara System (HCPCS E0469), are NOT covered for any indication due to insufficient clinical evidence. This is a non-coverage determination effective 07/22/2026. Billing teams must deny all claims for this service and educate providers that requests will be consistently denied under this plan.
Action Required
Before 07/22/2026: Billing team must update system edits to automatically deny all claims with HCPCS code E0469 for Humana Medicaid Virginia members. Add denial message stating 'Multi-function oscillation lung expansion therapy is not a covered service under this plan.' Update provider communications and Prior Authorization (PA) system to reflect non-coverage status—do NOT process PA requests for E0469. Flag any existing pending claims for E0469 and issue denials. Notify respiratory therapy and pulmonology providers of the non-coverage determination to prevent future claim submission attempts. Document this policy change in billing procedures and staff training materials.