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December 2016 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 : Vaporizers
Vaporizers may be reimbursed for purchase only, and that purchase is limited to 1 every 5 years.
Providers must use procedure code E0605 when billing for vaporizers. Vaporizer use is associated with a risk of bronchospasm, infection, edema of the airway, and client, caregiver, parent or guardian exposure to airborne microorganisms.
Vaporizers require prior authorization for limited indications that includes one of the following:
Prior authorization for use beyond the clinical indications listed above is only considered with clinical documentation that demonstrates that the benefit of the use of the device outweighs the noted risks.

Texas Medicaid & Healthcare Partnership
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