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Nebulizer Appendix A - Centers for Medicare - nebulizer treatment icd 10 pcs


Nebulizer Appendix A - Centers for Medicare-nebulizer treatment icd 10 pcs

DRAFT
Appendix A
Includes the following information from the Local Coverage Determination (lLCD): NEBULIZERS
(L33370)
https://www.cms.gov/medicare-coverage-database/details/lcd-
details.aspx?LCDId=33370&ver=14&SearchType=Advanced&CoverageSelection=Local&ArticleType=SAD
%7cEd&PolicyType=Both&s=All&CntrctrType=10&KeyWord=nebulizers&KeyWordLookUp=Doc&KeyWor
dSearchType=Exact&kq=true&bc=IAAAACAAAAAAAA%3d%3d&
1. Examples of Pulmonary/Lung Diseases Supporting Use of Nebulized FDA-Approved Drugs
2. FDA-Approved Nebulizers/Related Compressors-Accessories
3. FDA-Approved Inhalation Drugs/Related Nebulizers/Related Compressors-Accessories
4. Maximum Milligrams/Month in Dosing of FDA-Approved Inhalation Drugs
5. Usual Maximum Replacement for the FDA-Approved Accessory
6. Compounded/Non-FDA-Approved Inhalation Drugs - Not Covered by Medicare
Diagnosis Compressor/ Related FDA Approved
Generator Accessories Inhalation Comments
Solution(s)
Obstructive E0570 Small Volume albuterol (J7611,
Pulmonary Nebulizer J7613)
Disease A7003, arformoterol
(J41.0 - J70.9) A7004, (J7605)
A7005 budesonide
(J7626)
cromolyn (J7631)
formoterol
(J7606)
ipratropium
(J7644)
levalbuterol
(J7612, J7614)
metaproterenol
(J7669)
Cystic Fibrosis E0570 Small Volume dornase alpha
(E84.0) Nebulizer (J7639)
A7003, tobramycin
A7004, (J7682)
A7005 acetylcysteine
(J7608)
Bronchiectasis E0570 Small Volume tobramycin
2? Nebulizer (J7682)
(A15.0, J47.0, A7003,
J47.1, J47.9, A7004,
Nebulizers -- Appendix A Draft R1.0a 4/30/2018 1
DRAFT
Q33.4) A7005
HIV, E0570 Small Volume pentamidine
pneumocystosis, or Nebulizer (J2545)
complications of A7003,
organ transplants A7004,
(B20 and B59) A7005
(T86.00 - T86.99)
Persistent thick or E0570 Small Volume acetylcysteine
tenacious Nebulizer (J7608)
pulmonary secretions A7003,
(A22.1, A37.01 - A7004,
A37.91, A48.1, B25.0, A7005
B44.0, B77.81, E84.0,
J09.X1 - J09.9X,
J10.00 - J10.2, J10.81
- J10.89, J11.00,
J11.08, J11.1, J11.2,
J11.81 - J11.89, J12.0
- J12.3, J12.81,
J12.89, J12.9, J13,
J14, J15.0, J15.1,
J15.20 - J15.29, J15.3
- J15.9, J16.0, J16.8,
J18.0, J18.8, J18.9,
J40 - J47.9, J60 -
J69.8, J70.0 - J70.9)
Thick, tenacious E0565 Large Volume Acetylcysteine E0575
secretions, who has E0572 Nebulizer (J7608)
cystic fibrosis, A7007, A7017 No proven clinical advantage
bronchiectasis, a Combination and over a pneumatic compressor
tracheostomy, or a code E0585 Water or and nebulizer
tracheobronchial (Also Saline
stent covered) A4217, A7018
(A15.0, E84.0, J39.8,
J47.0, J47.1, J47.9,
J98.00,
Q33.4, Z43.0, Z93.0)
HIV, E0565 or Filtered pentamidine
pneumocystosis, or E0572 Nebulizer (J2545)
complications of A7006
organ transplants
(A15.0, B20 and B59)
(E84.0, J39.8, J47.0,
J47.1, J47.9, J98.09,
Q33.4, T86.00 -
T86.40)
Nebulizers -- Appendix A Draft R1.0a 4/30/2018 2
DRAFT
Pulmonary Artery E0574 A7014, treprostinil Covered when all of the
Hypertension A7016 (J7686) following criteria 1-3 listed
Pulmonary Artery K0730 A7005 Loprost below are
Hypertension (Q4074) met:
1. The beneficiary has a diagnosis of pulmonary artery hypertension
(Applicable Diagnosis Codes that Support Medical Necessity:
? I27.0 Primary pulmonary hypertension
? I27.2 Other secondary pulmonary hypertension
? I27.89 Other specified pulmonary heart diseases); and
2. The pulmonary hypertension is not secondary to pulmonary venous hypertension (e.g., left sided
atrial or ventricular disease, left sided valvular heart disease, etc.) or disorders of the respiratory
system (e.g., chronic obstructive pulmonary disease, interstitial lung disease, obstructive sleep
apnea or other sleep disordered breathing, alveolar hypoventilation disorders, etc.); and
3. The beneficiary has primary pulmonary hypertension or pulmonary hypertension which is
secondary to one of the following conditions:
? connective tissue disease,
? thromboembolic disease of the pulmonary arteries,
? human immunodeficiency virus (HIV) infection,
? cirrhosis,
? diet drugs
? anorexigens, or congenital left to right shunts.
If these conditions are present, the following criteria (a-d) must be met:
a. The pulmonary hypertension has progressed despite maximal medical and/or surgical
treatment of the identified condition; and
b. The mean pulmonary artery pressure is > 25 mm Hg at rest or > 30 mm Hg with exertion;
and
c. The beneficiary has significant symptoms from the pulmonary hypertension (i.e., severe
dyspnea on exertion, and either fatigability, angina, or syncope); and
d. Treatment with oral calcium channel blocking agents has been tried and failed, or has
been considered and ruled out.
If the above criteria are not met, code E0574 and the related drug (J7686 for treprostinil) or code K0730
and the related drug (Q4074 for iloprost) will be denied as not reasonable and necessary.
A controlled dose inhalation drug delivery system (K0730) is covered when it is reasonable and necessary to
deliver iloprost (Q4074) to beneficiaries with pulmonary hypertension only. (Applicable Diagnosis Codes
that Support Medical Necessity:
? I27.0 Primary pulmonary hypertension
? I27.2 Other secondary pulmonary hypertension
? I27.89 Other specified pulmonary heart diseases) ;).
Claims for code K0730 for use with other inhalation solutions will be denied as not reasonable and
necessary.
Nebulizers -- Appendix A Draft R1.0a 4/30/2018 3

What is the CPT code for nebulizer?code E0585 (Also covered) Large Volume Nebulizer . A7007, A7017 . and . Water or Saline . A4217, A7018 . Acetylcysteine (J7608) E0575 . ... If none of the drugs used with a nebulizer are covered, the compressor, the nebulizer, and other related accessories/supplies will be denied as not reasonable and necessary.