Nebulizers, pneumatic or ultrasonic, are devices which use either compressed gas or high-frequency electric oscillations to aerosolize liquid medication into a fine mist for inhalation into the lower-respiratory tract. The medications are delivered either continuously or intermittently via a facemask or mouthpiece.

Pneumatic Nebulizers

A small volume, nonfiltered nebulizer with compressor may be considered medically necessary for the administration of ANY of the following medications:

• Beta-adrenergics (albuterol, isoproterenol, isoetharine, levalbuteral, metaproterenol), anticholinergics (ipratropium), corticosteroids (budesonide), and cromolyn for the management of chronic obstructive pulmonary diseases (COPD) (e.g., chronic bronchitis, emphysema, asthma, etc.); or
• Antibiotics (Amikacin, Gentamycin, or Tobramycin) for individuals with cystic fibrosis (CF) or bronchiectasis; or
• Dornase  alfa (Pulmozyme) for individuals with CF or primary ciliary dyskinesia ; or
• Acetylcysteine for individuals with persistent thick or tenacious secretions; or
• Epinephrine for individuals with croup; or
• Colistin for multi-drug resistant P. aeruginosa pneumonia failing to improve on IV therapy; or
• Aztreonam inhalation solution (Cayston) to persons with CF with Pseudomonas aeruginosa; or
• Formoterol (Perforomist) or arformoterol (Brovana) for the management of COPD.

A small volume, filtered nebulizer with compressor may be considered medically necessary for the administration of pentamidine for individuals with ANY of the following conditions:

• Human immunodeficiency virus (HIV); or
• Post-organ transplantation with complications; or
• Pneumocystosis.

A large volume nebulizer, with compressor, or a nebulizer with compressor and heater, may be considered medically necessary to deliver humidity to a person with thick, tenacious secretions, with ANY of the following indications

• Bronchiectasis; or
• CF; or
• Tracheobronchial stent; or
• Tracheostomy

A non-disposable reservoir bottle when used with large volume nebulizers is considered not medically necessary.

A prefilled disposable large volume nebulizer is non-covered.

An unfilled disposable large volume nebulizer is non-covered.

All other uses for the above pneumatic nebulizers are considered not medically necessary.

Ultrasonic Nebulizers

Ultrasonic nebulizers may be considered medically necessary for delivery of tobramycin (Tobi) for individuals with CF who meet the criteria for a standard nebulizer when ALL of the following indications are met:

• The individual meets the criteria for a standard nebulizer; and
• The primary care physician and specialist indicate that the individual has been compliant with other nebulizer and medication therapy; and
• The use of a standard nebulizer has failed to control the individual's disease and prevent the individual from utilizing the hospital or emergency room.

A large volume ultrasonic nebulizer has no proven clinical advantage over a pneumatic compressor and nebulizer and will be denied as not medically necessary.

Accessories may be considered medically necessary when the nebulizer, compressor, and medications are medically necessary. 

The following table lists the usual maximum frequency of replacement for accessories. Claims for more than the usual maximum replacement amount will be denied as not medically necessary:

Total payments for a rental item may not exceed its allowable purchase price, except for those items identified as life sustaining DME.

The use of nebulizers is typically an outpatient service which is only eligible for coverage as an inpatient service in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.