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Medicare Covered Diagnosis for Bronchodilator Medications

491.0 - Simple Chronic Bronchitis
491.1 - Mucopurulent Chronic Bronchitis
491.2 - Chronic Obstructive Bronchitis
491.9 - Bronchitis, Chronic
492.8 - Emphysema, Severe
493 - Asthma
493.0 - Asthma, Extrinsic Asthma
493.00 - Asthma without mention of status Asthmaticus
453.01 - Asthma with status Asthmaticus
493.1 - Asthma, intrinsic late onset Asthma
493.2 - Asthma, Chronic Obstructive
493.20 - Chronic Obstructive Asthma
493.9 - Asthma, unspecified (Bronchial)
493.94 - Asthma, Bronchial Severe
494 - Bronchiectasis
495.2 - Bird Fancier's Disease
496 - Severe Chronic Obstructive Pulmonary Disease

A small volume nebulizer (A7043, A7404, A7005) and related compressor (E0570, E0571)
are covered when:

  1. It is medically necessary to administer beta-adrenergics, anticholinergics, corticosteroids, and cromolyn for the management of obstructive pulmonary disease (ICD-9 diagnosis codes 491.0 - 545), or
  2. It is medically necessary to administer gentamicin, tobramycin, amikacin, or dornase alfa to a patient with cystic fibrosis (ICD-9 diagnosis code 277.40) or
  3. it is medically necessary to administer pentarmidine to patients with HIV (ICb-9 diagnosis code 042), pneumotystosis (ZCp-9 diagnosis code 136.3), and complications of organ transplants (ICD-9 diagnosis codes 996.80-996.89), or
  4. It is medically necessary to administer mucolytics (other than dornase alpha) for persistent thick or tenacious pulmonary secretions (ICD-9 diagnosis codes 480.0-505, and 786.4).

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. 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.

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