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 Modifiers
  • JW - drug amount discarded/not administered to any patient
    • Indicated for discarded drugs and biologicals from "single use vials or single use packages."
    • 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.
  • JZ - zero drug amount discarded/not administered to any patient
    • Effective for use January 1, 2023, and,
    • Required for use on applicable claims with dates of service July 1, 2023
  • Indicated when there are no discarded amounts from "single use vials or single use packages."
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 Feb 19 , 2024

Related Articles

paginationType noridian
Articles Source Posted
Policy Article Revisions Summary for March 14, 2024 03/14/2024
LCD and Policy Article Revisions Summary for December 14, 2023 12/14/2023
Policy Article Revisions Summary for October 5, 2023 10/05/2023
LCD and Policy Article Revisions Summary for June 15, 2023 06/15/2023
Nebulizer Drug Calculator Tool Does All the Work 11/10/2022
Nebulizers - Final LCD and Response to Comments (RTC) Article Published 04/21/2022
LCD and Policy Article Revisions Summary for April 21, 2022 04/21/2022