Nebulizers - Policy Article

Nebulizers are covered under the DME benefit when they meet LCD reasonable-and-necessary requirements; unfilled nebulizers (A7007/A7017/E0585) filled by the beneficiary are acceptable alternatives. Specific items are noncovered (e.g., prefilled disposable nebulizers A7008, nebulizers and accessories for aztreonam lysine or amikacin liposome under Part B, cleaning kits, devices used primarily for room humidification), and Final Rule 1713 items require a face-to-face encounter and a Written Order Prior to Delivery. Dispensing fee rules (G0333 initial once-in-lifetime; Q0513/Q0514 for 30/90-day fees) and modifier (JW/JZ) and billing requirements (diagnosis code on each claim; fees billed on same claim) must be followed; Medicare limits dispensing fees timing and total months payable.

"Nebulizers are covered under the Durable Medical Equipment (DME) benefit when the reasonable and necessary (R&N) requirements in the related Local Coverage Determination (LCD) are met."