Every policy word on this page is CMS's own. Verzi adds pins, receipts, and links only.
Intrapulmonary Percussive Ventilation System
LCD L33786 · CMS's HCPCS descriptor for E0481: Intrapulmonary percussive ventilation system and related accessories.
Not on CMS's Required Prior Authorization List for DMEPOS on 2026-10-13. source
LCD L33786 · 6 versions, 2015 to today · last changed 2020-01-01 (R5)
Version 5 of LCD L33786: in force by CMS's dates 2016-07-01 to 2016-12-31. The policy text on this page comes from this archived version. On its start date, 2016-07-01, the companion Article in force was Article A52495 version 3.
JA · Noridian 16013
JB · CGS 17013
JC · CGS 18003
JD · Noridian 19003
source
CMS's Who are the MACs jurisdiction pages (DME facts as of 2025-09-30) name each contractor and its states; the MCD's Contractor Information table on every DME LCD prints the contract numbers. Both read 2026-10-09. Verzi adds the state lookup only.
Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Coding Information · Associated Information. Plus 4 sections marked N/A in this version.
Full verbatim text serves to customers · Customer? Log in
Version history, LCD L33786
CMS numbers each version. Each box shows the version's window by CMS's stated dates. Select a version to show it on this page. Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask. Version numbers CMS never published to its archive do not exist as documents.
Revision history, every version
CMS's own change log, quoted, 5 entries. It does not change with the version shown. A revision (R-number) is a change CMS logged. The version (vN) is the snapshot that carries it.
R5 · 2020-01-01 · v16
Revision Effective Date: 01/01/2020 CODING INFORMATION: Removed: Field titled “Bill Type” Removed: Field titled “Revenue Codes” Removed: Field titled “ICD-10 Codes that Support Medical Necessity” Removed: Field titled “ICD-10 Codes that DO NOT Support Medical Necessity” Removed: Field titled “Additional ICD-10 Information” As required by CR 10901, the ICD-10 information has been moved to all Policy Articles. There is no change in coverage.
R4 · 2020-01-01 · v14
Revision Effective Date: 01/01/2020 COVERAGE INDICATIONS, LIMITATIONS, AND/OR MEDICAL NECESSITY: Revised: Order information as a result of Final Rule 1713 DOCUMENTATION REQUIREMENTS: Revised: “physician's” to “treating practitioner's” Removed: Order direction and EY modifier information, due to updated requirements having been incorporated into the Standard Documentation Requirements article GENERAL DOCUMENTATION REQUIREMENTS: Revised: Prescriptions (orders) to SWO 02/13/2020: Pursuant to the 21st Century Cures Act, these revisions do not require notice and comment because they are due to non-discretionary coverage updates reflective of CMS FR-1713.
R3 · 2017-01-01 · v7
Revision Effective Date: 01/01/2017 COVERAGE INDICATIONS, INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Removed: Standard Documentation Language Added: New reference language and directions to Standard Documentation Requirements Added: General Requirements DOCUMENTATION REQUIREMENTS: Added: General Documentation Requirements Added: New reference language and directions to Standard Documentation Requirements POLICY SPECIFIC DOCUMENTATION REQUIREMENTS: Added: Direction to Standard Documentation Requirements Removed: Supplier Manual Reference from Miscellaneous Removed: PIM reference from Appendices RELATED LOCAL COVERAGE DOCUMENTS: Added: LCD-related Standard Documentation Requirements article
R2 · 2016-07-01 · v5
Effective July 1, 2016 oversight for DME MAC LCDs is the responsibility of CGS Administrators, LLC 18003 and 17013 and Noridian Healthcare Solutions, LLC 19003 and 16013. No other changes have been made to the LCDs.
R1 · 2015-10-01 · v3
Revision Effective Date: 10/31/2014 COVERAGE INDICATIONS, LIMITATIONS AND/OR MEDICAL NECESSITY: Revised: Standard Documentation Language to add covered prior to a beneficiary’s Medicare eligibility DOCUMENTATION REQUIREMENTS: Added: PIM citation reference under Appendices
Receipts for auditors
Version 5 of LCD L33786, shown on this page: in force by CMS's dates 2016-07-01 to 2016-12-31. Archived 2026-09-26. CMS's copy · Our archived file. 8 of 8 sections are proven word-identical to the archived file.
Every archived version of LCD L33786 (6 versions, CMS's dates, window by the as-of rule).
| Document | Version | In force | Archived on | Verify |
|---|---|---|---|---|
| LCD L33786 | version 2 | 2015-10-01, superseded same day | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33786 | version 3 | 2015-10-01 to 2016-06-30 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33786 | version 5 shown | 2016-07-01 to 2016-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33786 | version 7 | 2017-01-01 to 2019-12-31 | 2026-09-26 | CMS's copy · Our archived file |
| LCD L33786 | version 14 | 2020-01-01, superseded same day | 2026-10-09 | CMS's copy · Our archived file |
| LCD L33786 | version 16 | 2020-01-01 to today | 2026-09-26 | CMS's copy · Our archived file |
The related Articles each have their own receipts: Article A55426 · Article A52495.
Each archived file's page gives its sha256 fingerprint. A copy of the file hashes to the same value, byte for byte.
CMS's live page shows only the current version. To check a passage by eye, open CMS's copy of the same version number. A version's window ends on the earlier of CMS's stated end date and the day before the next version starts.
Every policy word on this page is CMS's, from the archived version named beside it. Verzi adds labels, highlights, citations and links only. Verzi-written summary content on this page: none.
Governing policies, as CMS lists them:
- LCD L33786 · Intrapulmonary Percussive Ventilation System
CMS lists E0481 in group 1 of version 16. CMS's description, quoted: “INTRAPULMONARY PERCUSSIVE VENTILATION SYSTEM AND RELATED ACCESSORIES”.
Related Articles, as CMS lists them: Article A55426 · Article A52495
From CMS's LCD code table. HCPCS Level II codes only.
source
CMS's LCD code table in the Medicare Coverage Database download, archived 2026-10-09: Our archived file.
Watch E0481
One email when any policy cited for E0481 changes or gains a future effective date. Nothing else, ever.