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December 2016 Texas Medicaid Provider Procedures Manual

Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook : 9 Physician : 9.2 Services, Benefits, Limitations, and Prior Authorization : 9.2.3 Aerosol Treatment

9.2.3
Nebulized aerosol treatments (procedure codes 94640, 94644, and 94645) with short-acting beta-agonists are a benefit of Texas Medicaid and considered medically necessary when breathing is compromised by certain acute medical conditions. Documentation to support an aerosol treatment for the worsening of an acute or chronic condition must be maintained in the client’s medical record and is subject to retrospective review.
Procedure code 94645 is only a benefit in the outpatient setting, specifically in a hospital emergency department or an urgent care clinic.
Pulse oximetry and evaluation of the client’s use of an aerosol generator, nebulizer, or metered-dose inhaler are considered part of an evaluation and management (E/M) visit and will not be reimbursed separately.
Hypertonic saline used in aerosol therapy will be denied if billed separately.
Refer to:
Subsection 4.2.20.1, “Aerosol Treatment” in the Inpatient and Outpatient Hospital Services Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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