Description:

A filtered air compressor used to nebulize unit dose medications. A nebulizer is an effective method of delivering respiratory medications.

Medicare's Medical Coverage Criteria:

A small volume nebulizer and related compressor are covered when:

  • It is medically necessary to administer beta-adrenergics, anticholinergics, corticosteriods, and cromolyn for the management of obstructive pulmonary disease, or
  • It is medically necessary to administer gentamicin, tobramycin, amikacin, or dornase alfa to a patient with cystic fibrosis, or
  • It is medically necessary to administer pentamidine to patients with HIV, or complications of organ transplants, or
  • It is medically necessary to administer mucolytics for persistent thick or tenacious pulmonary secretions.

Use of inhalation drugs, other than those listed above, will be denied as not medically necessary.

For criterion (a) to be met, the physician must have considered use of a metered dose inhaler (MDI) with and without a reservoir or spacer device and decided that, for medical reasons, it was not sufficient for the administration of needed inhalation drugs.

Nebulizer used for Respiratory Medications

Nebulizer

CLOSE WINDOW

 

The reason for requiring a small volume nebulizer and related compressor/generator instead of or in addition to an MDI must be documented in the patient’s medical record and be available to the DMERC on request.

If none of the drugs used with a nebulizer are covered, the nebulizer and its accessories/supplies will be denied as not medically necessary.