Nebulizer Documentation Needs (ACA, Face to Face visit required)
The following qualification criteria need to be documented in the patients’ medical record notes to qualify for the prescribed equipment. Note: Face to face and justification notes are valid for six months.

All of the following need to be sufficiently documented to support the need for the prescribed equipment.

  • Explain why it is reasonable and necessary to administer medications.
  • Document the medication that needs to be administered and the frequency of use.
  • Drug prescription including, Drug, Dosage, Route, frequency of use, Duration, quantity to be dispensed and number of refills. Note: Medical equipment provider must receive a copy of the prescription.

Note: If the prescribed drug(s) used with the nebulizer are not covered, the compressor and related supplies will be denied as not reasonable and necessary

Covered Inhalation Drugs and Solutions
Acetylcysteine
Metaproterenol
Pentamidine
Treprostinil
Albuterol
Albuterol/Ipratroprium combination
Levalbuterol
Metaproterenol
Albuterol
Albuterol/Ipratropium combination
Arformoterol
Budesonide
Cromolyn sodium
Dornase alpha
Formoterol
Ipratropium bromide
Levalbuterol

Diagnosis: See LCD (Local coverage determination) at NGSMedicare.com for any additional qualifying information questions, diagnosis codes and descriptions

Medicare approved detailed equipment descriptions for Nebulizer and supplies
Nebulizer with compressor,  (HCPC-E0570)
Nebulizer supplies – reusable nebulizer kit, disposable nebulizer kit, aerosol mask, filter, document drug to be administered and the frequency of use
Ultrasonic nebulizer with compressor, (HCPC-E0575)
Supplies -2 ultrasonic nebulizer kits, document drug to be administered and the frequency of use

Patient notes/justification – Must be documented using your normal dictation process. Letter of medical necessity, notes wrote on letter head or prescriptions are not valid.

Prescription/order requirements – Must contain Patient’s name, date of the order and Start date, detailed equipment description (See above), Physician’s NPI (national provider number), signature of the ordering physician and a signature date.