VERZIHEALTHGet a key
Coverage Knowledge Base

Every policy word on this page is CMS's own. Verzi adds pins, receipts, and links only.

Intrapulmonary Percussive Ventilation System

LCD L33786 · 6 versions, 2015 to today · last changed 2020-01-01 (R5)

Version 16 of LCD L33786: in force by CMS's dates 2020-01-01 onward. The policy text on this page comes from this archived version.

DME MAC jurisdictions
JA · Noridian 16013
CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, VT
JB · CGS 17013
IL, IN, KY, MI, MN, OH, WI
JC · CGS 18003
AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, PR, SC, TN, TX, VI, VA, WV
JD · Noridian 19003
AK, AS, AZ, CA, GU, HI, ID, IA, KS, MO, MT, NE, NV, ND, MP, OR, SD, UT, WA, WY
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.

Codes CMS lists in this LCD (version 16, 1 code): E0481

CMS's newest revision note (R5, 2020-01-01), quoted

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.
source

This quote comes from CMS's revision-history file, not from the version's own file: Our archived file.

Sections in this version: CMS National Coverage Policy · Coverage Indications, Limitations, and/or Medical Necessity · Associated Information. Plus 10 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 Versions superseded the same day they took effect never governed a claim, so the page hides them until you ask.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.

v22015-10-01, superseded same dayv32015-10-01 to 2016-06-30v52016-07-01 to 2016-12-31v72017-01-01 to 2019-12-31v142020-01-01, superseded same dayv162020-01-01 to today

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 16 of LCD L33786, shown on this page: in force by CMS's dates 2020-01-01 onward. Archived 2026-09-26. CMS's copy · Our archived file. 13 of 13 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). The Article rows are the Article versions in force on the start dates of these LCD versions.

DocumentVersionIn forceArchived onVerify
LCD L33786version 22015-10-01, superseded same day2026-09-26CMS's copy · Our archived file
LCD L33786version 32015-10-01 to 2016-06-302026-09-26CMS's copy · Our archived file
LCD L33786version 52016-07-01 to 2016-12-312026-09-26CMS's copy · Our archived file
LCD L33786version 72017-01-01 to 2019-12-312026-09-26CMS's copy · Our archived file
LCD L33786version 142020-01-01, superseded same day2026-10-09CMS's copy · Our archived file
LCD L33786version 16 shown2020-01-01 to today2026-09-26CMS's copy · Our archived file
Article A52495version 22015-10-01 to 2016-06-302026-09-26CMS's copy · Our archived file
Article A52495version 32016-07-01 to 2016-12-312026-09-26CMS's copy · Our archived file
Article A52495version 102017-01-01 to 2019-12-312026-09-26CMS's copy · Our archived file
Article A52495version 182020-01-01 to today2026-09-26CMS's copy · Our archived file
Article A55426version 122017-01-01 to 2017-04-192026-09-26CMS's copy · Our archived file
Article A55426version 722020-01-01 to 2020-04-052026-09-26CMS's copy · Our archived file

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.