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2012 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2. Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.19 Respiratory Equipment and Supplies : 2.2.19.2 Nebulizers

2.2.19.2
Nebulizers may be reimbursed for purchase only, and that purchase is limited to 1 every 5 years. Providers must use procedure code E0570 when billing for the purchase of the nebulizer.
For fee-for-service, medications that are used with the nebulizer will not be reimbursed to a DME company. These medications may be considered under the Vendor Drug Program.
Refer to:
Appendix B: Vendor Drug Program (Vol. 1, General Information) for more information about VDP.
2.2.19.2.1 Prior Authorization
Nebulizers do not require prior authorization for the diagnoses listed below. Other diagnoses require prior authorization and may be considered based on review of documentation by HHSC or its designee.
The following nebulizer supplies may be billed with the diagnosis codes listed above:
Ultrasonic nebulizers do not require prior authorization for diagnoses codes listed with documentation for failure of standard therapy. Providers must use procedure code E0574 or E0575 when billing for the purchase of the ultrasonic nebulizer. The ultrasonic nebulizer may be reimbursed only for diagnosis codes 1363, 27700, 27701, 27702, 27703, and 27709. The ultrasonic nebulizer requires prior authorization for all other diagnoses.
Providers must use procedure code A7009, A7014, or A7016 when billing supplies with an ultrasonic nebulizer.

Texas Medicaid & Healthcare Partnership
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