Coding

The Medicare/Medicaid HCPCS code for the OxyPhone is A7005, modifier NU.(Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable).  (June 1, 2007; SADMERC)

This can be distributed from a physicians office without prior authorization.

The Oxyphone can be refilled at least 2 times/year by CMS guidelines. (Durable Medical Equipment (DME) Procedure Codes and Modifiers).  Refills vary from state to state within the Medicaid system.

Some of the ICD-9 codes consistent with use of A7005 are:

  • 493.0     Extrinsic asthma (childhood asthma)
  • 493.1     Intrinsic asthma
  • 493.81   Exercise induced bronchospasm
  • 493.82   Cough variant asthma
  • 493.9     Asthma, unspecified   [Asthma (bronchial) (allergic NOS)] 464.4     Croup
  •  
  • 466.0     Acute bronchitis (includes that with bronchospasm)
  • 466.11  Acute bronchiolitis due to RSV
  • 770.7    Chronic respiratory disease arising in the perinatal period (BPD)
  • 786.07  Wheezing
Some Medicare Coverage Rules that should be noted (Partial Overview):
  1. A small volume nebulizer (A7003, A7004, 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 - 505), or
    2. It is medically necessary to administer gentamicin, tobramycin, amikacin, or dornase alfa to a patient with cystic fibrosis (ICD-9 diagnosis code 277.00) or
    3. It is medically necessary to administer pentamidine to patients with HIV (ICD-9 diagnosis code 042), pneumocystosis (ICD-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).