Current through Register Vol. 24-18, September 15, 2024
(1) The medicaid
agency covers, without prior authorization, the purchase of a nebulizer and
related compressor, with limits, when the following medicare clinical criteria
are met.
(a) Small volume nebulizer and
related compressor for the administration of inhalation drugs for:
(i) The management of obstructive pulmonary
disease;
(ii) A client with cystic
fibrosis or bronchiectasis;
(iii) A
client with HIV, pneumocystosis, or complications of organ transplants;
or
(iv) Persistent, thick, or
tenacious pulmonary secretions.
(b) Large volume nebulizer and related
compressor to deliver humidity to a client with thick, tenacious secretions and
who has one or more of the following:
(i)
Cystic fibrosis;
(ii)
Bronchiectasis;
(iii) A
tracheostomy; or
(iv) A
tracheobronchial stent.
(c) Filtered nebulizer when necessary to
administer pentamidine to clients with HIV, pneumocystosis, or complications of
organ transplants.
(2)
The medicaid agency limits payments, per client, as follows:
(a) Compressor - One every five years.
Requires thirteen months rental first. After thirteen months, the compressor is
considered purchased.
(b) Nebulizer
with compressor - One every five years. Reimbursement includes instruction on
the proper use and cleaning of the equipment.
(3) The medicaid agency pays separately for
medically necessary accessories as follows:
(a) Administration set. Purchase only.
(i) With small volume filtered or nonfiltered
pneumatic nebulizer, disposable. Limited to one per client every thirty
days.
(ii) With small volume
nonfiltered pneumatic nebulizer, nondisposable. Limited to one per client every
six months.
(b) Aerosol
mask, used with nebulizer. Purchase only. Limited to one per client every
thirty days.
(c) Corrugated tubing,
used with large volume nebulizer. Purchase only.
(i) Disposable, limited to one unit (one
hundred feet) per client every sixty days.
(ii) Nondisposable, limited to one unit (ten
feet) per client every twelve months.
(d) Face tent. Purchase only. Limited to one
per client every thirty days.
(e)
Filter. Purchase only.
(i) Disposable,
limited to two per client every thirty days.
(ii) Nondisposable, limited to one per client
every ninety days.
(f)
Large volume nebulizer, disposable, unfilled, used with aerosol compressor.
Limited to ten per client every thirty days.
(g) Small volume nonfiltered pneumatic
nebulizer, disposable. Purchase only. Limited to two per client every thirty
days.
(h) Tracheostomy mask, each.
Purchase only. Limited to four per client every thirty days.
(i) Heated humidifier with temperature
monitor and alarm for clients who have a tracheostomy but who are not
ventilator dependent. Monthly rental only. Prior authorization is
required.
(j) Water collection
device, used with large volume nebulizer. Purchase only. Limited to eight per
client every thirty days.
(k)
Water, distilled, used with large volume nebulizer, 1000 ml. Limited to fifty
units per client every thirty days.
(l) Immersion external heater for a
nebulizer. Purchase only. Prior authorization is required.
(4) Providers must monitor the amount of
supplies and accessories a client is actually using and assure that the client
has nearly exhausted the supply on hand prior to dispensing any additional
items.
(5) The medicaid agency does
not pay for a large volume nebulizer, related compressor/generator, and water
or saline when used predominantly to provide room humidification.
Statutory Authority:
RCW
41.05.021. 12-14-022, §182-552-0650,
filed 6/25/12, effective 8/1/12.
