Table of Contents Previous Next Index

2012 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 8. Physician : 8.2 Services, Benefits, Limitations, and Prior Authorization : 8.2.3 Aerosol Treatment

8.2.3
Aerosol treatment (procedure codes 94640, 94644, and 94645) for aerosol therapy is a benefit of Texas Medicaid and is limited to the following diagnosis codes:
Procedure codes J7605, J7608, J7622, J7626, J7631, J7633, J7639, J7644, and J7682 are limited to the following diagnosis codes:
Diagnoses not listed above may be considered with supporting documentation of medical necessity.
Medications used in aerosol therapy, when billed by the provider, are reimbursed separately and must be billed using the appropriate Healthcare Common Procedure Coding System (HCPCS) procedure code. A separate charge for saline used in aerosol therapy is denied as part of the aerosol therapy.
Refer to:
Subsection 8.2.57, “Pentamidine Aerosol,” in this handbook for a list of diagnosis codes that are valid for pentamidine aerosol treatments.
Subsection 8.2.36.2, “Vaccine and Toxoid Procedure Codes,” in this handbook for a list of diagnosis codes that are valid for the Bacillus Calmette-Guérin (BCG) vaccine.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2011 American Medical Association. All rights reserved.