CSHCN Services Program 2010 > Respiratory Equipment and Supplies > Benefits, Limitations, and Authorization Requirements

   
 

33.2.8 Nebulizers

A nebulizer may be rented or purchased for clients when:

The equipment is prescribed by a physician for an approved diagnosis.

The documentation submitted with the claim, the authorization, or prior authorization request supports medical necessity and appropriateness.

The purchase of nebulizers may be reimbursed with the anticipation that the equipment will last a minimum of 2 years with continuous use and up to 5 years with intermittent use.

The following procedure codes may be reimbursed for nebulizers and supplies:

Procedure Codes
Small Volume Nebulizer and Supplies

A7003

A7004

A7005

A7006

E0565

E0572

Large Volume Nebulizer and Supplies

A7007

A7008

E0585

Filtered Volume Nebulizer and Supplies

A7006

E0565

E0572

Ultrasonic Volume Nebulizer and Supplies

E0574

E0575

Authorization is not required for nebulizers if an approved diagnosis, listed in the table above, is submitted:

Small volume nebulizer with related compressor

Diagnosis Code
Description

042

Human immunodeficiency virus (HIV)

1363

Pneumocystosis

27700

Cystic fibrosis without mention of meconium ileus

27701

Cystic fibrosis with meconium ileus

27702

Cystic fibrosis with pulmonary manifestations

27703

Cystic fibrosis with gastrointestinal manifestations

27709

Cystic fibrosis with other manifestations

46611

Acute bronchiolitis due to respiratory syncytial virus (RSV)

46619

Acute bronchiolitis due to other infectious organisms

4800

Pneumonia due to adenorivus

4801

Pneumonia due to respiratory syncytial virus

4802

Pneumonia due to parainfluenza virus

4803

Pneumonia due to SARS-associated coronavirus

4808

Pneumonia due to other virus not elsewhere classified

4809

Unspecified viral pneumonia

481

Pneumococcal pneumonia (streptococcis pneumoniae pneumonia)

4820

Pneumonia due to Klebsiella pneumoniae

4821

Pneumonia due to Pseudomonas

4822

Pneumonia due to Hemoplilus influenzae (H.influenzae)

48230

Pneumonia due to unspecified Streptococcus

48231

Pneumonia due to Streptococcus, group A

48232

Pneumonia due to Streptococcus, group B

48239

Pneumonia due to other Streptococcus

48240

Pneumonia due to Staphylococcus, unspecified

48241

Methicillin susceptible Staphylococcus aureus

48242

Methicillin resistant pneumonia due to Staphylococcus aureus

48249

Other Staphylococcus pneumonia

48281

Pneumonia due to anaerobes

48282

Pneumonia due to Escherichia coli (E. coli)

48283

Pneumonia due to other gram-negative bacteria

48284

Legionnaires' disease

48289

Pneumonia due to other specified bacteria

4829

Unspecified bacterial pneumonia

4830

Pneumonia due to Mycoplasma pneumoniae

4831

Pneumonia due to Chlamydia

4838

Pneumonia due to other specified organism

4841

Pneumonia in cytomegalic inclusion disease

4843

Pneumonia in whooping cough

4845

Pneumonia in anthrax

4846

Pneumonia in aspergillosis

4847

Pneumonia in other systemic mycoses

4848

Pneumonia in other infectious diseases classified elsewhere

485

Bronchopneumonia, organism unspecified

486

Pneumonia, organism unspecified

4880

Influenza due to identified avian influenza virus

4881

Influenza due to identified novel h1n1 influenza virus

49300

Extrinsic asthma, unspecified

49301

Extrinsic asthma with status asthmaticus

49302

Extrinsic asthma with (acute) exacerbation

49310

Intrinsic asthma, unspecified

49311

Intrinsic asthma with status asthmaticus

49312

Intrinsic asthma with (acute) exacerbation

49320

Chronic obstructive asthma, unspecified

49321

Chronic obstructive asthma with status asthmaticus

49322

Chronic obstructive asthma with (acute) exacerbation

49381

Exercise induced bronchospasm

49382

Cough variant asthma

49390

Asthma, unspecified

49391

Asthma, unspecified, with status asthmaticus

49392

Asthma, unspecified with (acute) exacerbation

5070

Pneumonitis due to inhalation of food or vomitus

5071

Pneumonitis due to inhalation of oils and essences

74861

Congenital bronchiectasis

99680

Complications of transplanted organ, unspecified site

99681

Complications of transplanted kidney

99682

Complications of transplanted liver

99683

Complications of transplanted heart

99684

Complications of transplanted lung

99685

Complications of transplanted bone marrow

99686

Complications of transplanted pancreas

99687

Complications of transplanted organ, intestine

99689

Complications of other transplanted organ

Large Volume Nebulizer with Compressor

Diagnosis Code
Description

27700

Cystic fibrosis without mention of meconium ileus

27701

Cystic fibrosis with meconium ileus

27702

Cystic fibrosis with pulmonary manifestations

27703

Cystic fibrosis with gastrointestinal manifestations

27709

Cystic fibrosis with other manifestations

4940

Bronchiectasis without acute exacerbation

4941

Bronchiectasis with acute exacerbation

V440

Tracheostomy status

V550

Attention to tracheostomy

51919

Other diseases of trachea and bronchus

Filtered Nebulizer or Related Compressor

Diagnosis Code
Description

042

Human immunodeficiency virus (HIV)

99680

Complications of organ transplants, unspecified site

Prior authorization requests must be submitted in writing to the CSHCN Services Program and must document the medical necessity of a nebulizer for any diagnosis not listed above or to justify the purchase of more than one nebulizer.

The purchase of ultrasonic nebulizers (procedure codes E0574 and E0575) may be considered for prior authorization with documentation of the failure of standard therapy.


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