Mountain State Medical Policy Bulletin
Section: Durable Medical Equipment
Number: E-32
Topic: Nebulizers
Effective Date: August 1, 2005
Issued Date: September 10, 2007
Date Last Reviewed:

General Policy Guidelines

Indications and Limitations of Coverage

Nebulizers are covered when medically necessary for the administration of needed drugs. Accessories (A7005-A7006, A7009, A7012-A7015), such as a mouthpiece (A7016) and tubing (A7010, A7011), are considered eligible when used with a covered nebulizer.

In addition to glass or plastic nebulizers (A7017, E0580), disposable nebulizers are available in large and small sizes. Small volume disposable nebulizers (A7004) and accessories (A7003) used with them are eligible. However, large volume disposable nebulizers (A7007 and A7008) are considered convenience items, and therefore, are noncovered.

A large volume, non-disposable pneumatic nebulizer (E0580) and water (A7018) are not separately payable and should not be separately billed when used for patients with rented home oxygen equipment (E0424 and E0439).

Nebulizers are generally furnished in conjunction with an oxygen regulator or flowmeter. Therefore, separate charges for these items should be processed under the combined code E1353. If reported alone, a nebulizer should be processed under code E0580 or E0585.

See Medical Policy Bulletin E-11, Oxygen Concentrators and Related Durable Medical Equipment, for information on nebulizers/regulators billed in conjunction with oxygen concentrators.

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

The term "nebulizer" is generally used for the actual chamber in which the nebulization of liquid occurs. In order to achieve a functioning delivery system for aerosol therapy, nebulizers are attached to an aerosol compressor to achieve nebulization by means of airflow. To achieve nebulization by means of ultrasonic vibrations, they are attached to an ultrasonic generator.

Procedure Codes

A4619A7003A7004A7005A7006A7007
A7008A7009A7010A7011A7012A7013
A7014A7015A7016A7017A7018E0424
E0439E0565E0570E0571E0572E0575
E0580E0585E1353E1372  

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

MCIM 60-9

Region A Durable Medical Equipment Carrier 14.28

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Table Attachment

Text Attachment

Procedure Code Attachment


Glossary




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.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.