Spacers, either bag or reservoir type , (A4627, S8100, S8101) are considered eligible durable medical equipment for those patients with respiratory conditions, such as asthma (493.00-493.92) and cystic fibrosis (277.00-277.09). Spacers, bag or reservoir, provided for indications other than those referenced should be denied as not medically necessary. A participating, preferred, or network provider cannot bill the member for the denied service.

Spacers can be used repeatedly and can be cleaned following each use according to manufacturer instructions. Since MDI medications can be mixed in the same spacer, a separate device is not indicated for each MDI medication a patient may be using. However, spacers may be replaced as often as every 6 months or as needed, due to breakage and wear.

Coverage for DME is determined according to individual or group customer benefits.

NOTE:

Total payments for a rental item may not exceed its allowable purchase price, except for those items identified as life sustaining DME. For information on continuous rental of life sustaining DME, see Medical Policy Bulletin E-38, Continuous Rental of Life Sustaining Durable Medical Equipment (DME).

Description

These devices are aids to assist in the delivery of medication through metered dose inhalers (MDI). MDIs are medication delivery systems for aerosol medications. Use of an MDI requires the ability to spray medication into the mouth and inhale at the same time. This may be difficult in some circumstances, e.g., acute asthma attack and for some patients, e.g., small children. In circumstances such as these, the patient may not receive the benefit of the entire metered dose.

When a spacer is attached to a metered dose inhaler, there is no need to coordinate breathing with the spraying of medication because the spacer bag or reservoir retains the medication not delivered to the lungs during the first inhalation. This reduces the loss of medication during exhalation. Retention of the medication in the spacer permits the patient to inhale additional times to maximize the amount of medication they receive.

Use of the device also provides more effective medication delivery to the lungs by retaining the many smaller medication particles, which can penetrate most deeply into the lungs. On subsequent inhalations, these particles are delivered to the lungs. Also, larger medication particles are caught in the spacer preventing their deposit in the mouth and throat, thereby reducing irritation to these areas.

NOTE:

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.