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
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,Â (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.