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Revised: 08-01-2011

  • Overview
  • Eligible Providers
  • Eligible Recipients
  • Covered Services
  • Noncovered Services
  • Authorization
  • Billing
  • Overview

    Spirometers are Pulmonary Function Tests used to measure the volume/flow of inhaled and exhaled air.

    Eligible Providers

    The following providers may provide spirometers:

  • • Federally Qualified Health Center
  • • Home health agencies
  • • Indian Health Services
  • • Medical suppliers
  • • Pharmacies
  • • Rural Health Clinic
  • TPL and Medicare

    Providers must meet any provider criteria, including accreditation, for third party insurance or Medicare. This is to assist recipients for whom MHCP is not the primary payer.

    Eligible Recipients

    Spirometers are covered for home monitoring of pulmonary function of eligible MHCP recipients following lung or heart-lung transplants.

    Covered Services

    Codes: A9284 (non-electronic), E0487 (electronic)

    Only spirometers approved by the Food and Drug Administration (FDA) are covered. Do not use A9284 or E0487 for incentive spirometers.

    Noncovered Services

    Spirometers prescribed for home monitoring of recipients who have not had a lung or heart-lung transplant.


  • Authorization is always required for purchase or rental of a spirometer. All authorization requests must include:
  • • Date of lung or heart-lung transplant
  • • Statement detailing medical need for home monitoring, including specific patient orders
  • • If electronic spirometer is requested, explain why a non-electronic spirometer will not meet the recipient’s needs
  • Submit authorization request and required documentation to the authorization medical review agent.


    When billing with an approved authorization:

  • • Use MN–ITS 837P Professional
  • • Refer to the MN–ITS User Guide for DME, Medical Supplies, Prosthetic and Orthotic Services for detailed instructions.
  • • Enter the ordering provider in the Other Provider Types section of the Provider tab of the MN–ITS Interactive Claim
  • • Use the correct HCPCS code and the modifier NU or RR as noted on the authorization
  • Refer to the Billing section on the main Equipment & Supplies page and the Detailed Written Orders section for additional information.

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