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).
