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)
Some Medicare Coverage Rules that should be noted (Partial Overview):
- A small volume nebulizer (A7003, A7004, A7005) and related compressor (E0570, E0571) are covered when:
- 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
- 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
- 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
- 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).