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2012 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4. Outpatient Hospital (Medical/Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.19 Respiratory Services

4.2.19
4.2.19.1
Aerosol Treatment
Aerosol treatments, including vaporizers, humidifiers, nebulizers, and inhalers are a benefit of Texas Medicaid. Authorization is not required for aerosol treatments.
The following diagnosis codes are payable for aerosol treatments:
Revenue code 412 may be reimbursed separately when submitted for aerosol therapy in the recovery room after outpatient surgery, as it is a necessary adjunct to the postoperative recovery of a client who has undergone general anesthesia.
Outpatient facilities must submit claims for aerosol treatments using revenue code 412. Revenue code 412 includes the inhalers listed below and is payable once per day in the outpatient setting for either the aerosol therapy or the inhaler, but not both.
Beclomethasone dipropionate (Vanceril or Beclovent oral inhalers)
Isoproterenol sulfate (Iso-Autohaler, Luf-Iso Inhaler, Medihaler-Iso, Norisodrine Aerohaler)
Isoproterenol hydrochloride (Iprenol, Vapo-Iso inhalers)
Bilateral (Proventil or Ventolin inhalers)
Metaproterenol sulfate (Alupent Metered Dose inhaler, Metaprel inhaler, Alupent 10 mL, Alupent 30 mL)
Epinephrine bitartrate (Medihaler-Epi and Primatene Mist Suspension inhaler)
Dexamethasone sodium phosphate (Turbinaire or Respihaler)
Demonstration and evaluation of client utilization of an aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing (IPPB) device will not be reimbursed separately.
IPPB treatments have been determined to be inappropriate for the treatment of most respiratory problems and are denied.

Texas Medicaid & Healthcare Partnership
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