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Nebulizers

Coverage

Documentation

Reviews/Audits

  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review

Tips

Topic Details
Maximum Frequency replacement accessories
  • A4619, A7006, A7525, A7015: One/Month
  • A7003, A7007, A7012, A7013: Two/ Month
  • A7004: Two/ Month (in addition to A7003)
  • A7005: One/3 months only with K0730
  • A7005: One/6 months
  • A7010: One Unity (100ft.)/ 2 month
  • A7014: One/3 months
  • A7017, E1372: One/3 years
  • A7016: Two/Year
Drug Waste
  • Effective for claims with dates of service on or after January 1, 2017, if the coverage criteria for the infusion drugs are not met, claims billed for drug wastage with the JW modifier will be denied as not reasonable and necessary.
  • Effective for claims with dates of service on or after January 1, 2017, claims lines billed for drug wastage without a JW modifier will be denied as not reasonable and necessary.
Drugs: Maximum Milligrams/Month
  • Acetylcysteine: 74 grams/month
  • Albuterol: 465 mg/ month
  • Albuterol/Lpratropium combination: 186 units/ month
  • Arformoterol: 930 micrograms/month-62 units/month
  • Budesonide: 62 units/month
  • Cromolyn Sodium: 2480 mg/month 0248 units/month
  • Dornase Alfa: 78 mg/month
  • Formoterol: 1240 micrograms/month- 62 units/month
  • Ipratropium Bromide: 93 mg/month
  • Levalbuterol: 232.5 mg/month-465 units/month (see below for exception)
  • Metaproterenol: 2800mg/month-280 units/month
  • Pentamidine: 300mg/months
  • Revefenacin: 5250 mcg/month
  • Treprostinil: 31 units/month
  • Sterile Saline or water, 10ml/unit (A4216, A4218): 56 units/month
  • Distilled Water, sterile water, sterile saline in large volume nebulizer: 18 liters/month

 

Resources

 

Last Updated Wed, 20 Apr 2022 18:26:45 +0000

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

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