Article Detail - JD DME
RETIRED - Reminder - Ultrasonic/Electronic Aerosol Generator With Small Volume Nebulizer - Coding Verification Review Requirement
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Article retired due to content incorporation into the applicable Local Coverage Determination or related Policy Article.
Posted October 14, 2011
Recently it was brought to the attention of the Durable Medical Equipment Medicare Administrative Contractors (DME MAC) that suppliers and pharmacies are billing code E0574 (ULTRASONIC/ELECTRONIC AEROSOL GENERATOR WITH SMALL VOLUME NEBULIZER). The article published by the DME MACs on November 4, 2010 titled "Ultrasonic/Electronic Aerosol Generator with Small Volume Nebulizer - Coding Verification Review Requirement" required:
Effective for claims with dates of service on or after April 1, 2011, the only products which may be billed to Medicare using code E0574 (Ultrasonic/Electronic Aerosol Generator With Small Volume Nebulizer) are those for which a written coding verification has been made by the Pricing, Data Analysis, and Coding (PDAC) contractor and that are listed in the Product Classification Matrix of the DME Coding System (DMECS) maintained on the PDAC website.
Code E0574 and related accessories are reasonable and necessary to administer treprostinil inhalation solution (J7686) only. To date only one ultrasonic nebulizer has been approved to use code E0574 - Optineb-ir Model ON-100/7 (NebuTec, GmbH). There are no other nebulizers that are authorized to bill the DME MACs using code E0574. Suppliers billing for ultrasonic nebulizers not listed in the Product Classification Matrix of the DME Coding System (DMECS) must contact the PDAC for proper coding instructions.
With the exception of the Optineb-ir®, no other ultrasonic nebulizers have received approval to use code E0574 through the coding verification review process. Suppliers of ultrasonic nebulizers other than the Optineb-ir® who have incorrectly coded these items and had paid claims for E0574 with dates of service on or after April 1, 2011 should submit a voluntary refund. In addition, voluntary refunds should be submitted for paid claims for inhalation medications used in conjunction with an E0574 nebulizer.
The PDAC coding verification application required for these products is the DME and Supplies application. This application is located on the PDAC website. If you have questions please contact, the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website. Once products are coded by the PDAC, they will be listed in the Product Classification Matrix on DMECS.
