The following information describes the medical policy for nebulizer and nebulizer-related equipment. This is to be used only as a guide.
For an item to be covered, the following conditions apply: (1) item must be eligible for a defined insurance benefit category, (2) item must be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and (3) the item must meet all applicable statutory and regulatory requirements. Please refer to your insurance benefits or contact your medical director or provider helpline for specific instructions.
NEWS
ABOUT NEBULIZER COVERAGE
Compressor – An AC-powered device that delivers a fixed, low air pressure to a small volume nebulizer.Nebulizer – The actual chamber where the liquid medication is changed into an aerosol or mist. The nebulizer typically consists of the lid, jar (or cup), and baffles. An order for equipment, accessories, drugs and related supplies must be signed and dated by the physician and kept on file by the supplier. Each order must include a diagnosis indicating medical necessity for nebulizer therapy. Additionally, the patient’s record must contain supporting medical necessity documentation for each item ordered.
Your doctor will know what diagnosis will allow you to use nebulizer, but we have listed a few as an example for you.
Obstructive pulmonary disease ICD-9-CM codes: 491.0 – 508.9
Cystic fibrosis ICD-9-CM code: 277.02
HIV ICD-9-CM code: 042
Pneumocystosis ICD-9-CM code: 136.3
Complications of organ transplants ICD-9-CM codes: 996.80 – 996.89
For persistent thick or tenacious pulmonary secretions ICD-9-CM codes: 786.40 and 480.0 – 508.9
Brochiectasis ICD-9-CM codes: 494.0, 494.1, 748.61, 011.50 – 011.56, 277.02
Nebulizer Compressor
Medicine Dispenser
Masks
Pacifier Style
Reusable Mister
