Nebulizers
Medicare covers a nebulizer for patients whose ability to breathe is impaired and need this machine to deliver medications that treat certain respiratory problems. Theser machines, medications and related accessories are usually covered for patients with obstructive pulmonary disease, but can also be covered to deliver specific medications to several different types of patients. Respiratory problems may include chronic bronchitis, emphysema, cystic fibrosis, HIV, organ transplant complications, tracheostomy or other illnesses that cause thick mucous secretions.
Medicare Coverage Criteria (ONE of the following must be met):
- It is medically necessary to administer beta-adrenergics, anticholinergics, corticosteriods, and cromolyn for the management of obstructive pulmonary disease. (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.
- It is medically necessary to administer gentamicin, tobramycin, amikacin, or dornase alpha for cystic fibrosis.
- It is medically necessary to administer pentamidine to patients with HIV or complication of organ transplant.
- It is medically necessary to administer mucolytics (other than dornase alpha) for persistent or tenacious pulmonary secretions.
Note: Medicare does not cover disposable nebulizers; they are considered to be convenience items. Also, Medicare does not cover the nebulizer unless the related medication is covered.
An order (prescription) must be on file with the supplier. It must be signed and dated by the treating doctor. Nebulizers are in the Capped Rental category for durable medical equipment; that means you may choose to rent or purchase a nebulizer.
