Nebulizers

Revised: March 5, 2026

· Overview

· Eligible Providers

· TPL and Medicare

· Eligible Members

· Covered Services

· Authorization

· Billing

Overview

Nebulizers administer vaporized medication to individuals receiving nebulized medications.

Eligible Providers

The following may provide nebulizers:

· Federal qualified health centers

· Home health agencies

· Hospitals

· Indian Health Services

· Medical suppliers

· Pharmacies

· Rural health clinics

TPL and Medicare
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare to assist members for whom Minnesota Health Care Programs (MHCP) is not the primary payer.

MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested.

Refer to the Medicare and Other Insurance section of the MHCP Provider Manual for more information.

Eligible Members

Nebulizers are covered for eligible Medical Assistance and MinnesotaCare members with a variety of respiratory or pulmonary conditions and diseases and other serious conditions requiring nebulized medications.

Covered Services

Codes: A4617, A7003-A7018, E0565, E0570, E0572, E0574, E0575, E0580, E0585
MHCP covers the following equipment:

· Small-volume nonfiltered pneumatic nebulizers (A7004)

· Large-volume nebulizers (A7007, A7008)

· Compressors (E0565)

· Nebulizer, with compressor (E0570)

· Aerosol compressors, adjustable pressure, light duty for intermittent use (E0572)

· Ultrasonic or electronic aerosol generators with small volume nebulizer (E0574)

· Ultrasonic, large volume nebulizers (E0575)

· Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter (E0580)

· Nebulizer, with compressor and heater (E0585)

· Nebulizer, bottle type, not used with oxygen (A7017)

· Supplies for nebulizers, including:

· Administration sets (A7003, A7005, A7006)

· Water collection devices (A7012), reservoir bottles (A7009), and water (A7018)

· Corrugated tubing (A7010)

· Disposable (A7013) and nondisposable (A7014) filters

· Aerosol masks (A7015)

· Mouthpieces (A4617) and dome and mouthpieces (A7016)

Nebulizers (A7017, E0570, E0580, E0585) and compressors (E0565, E0572) are covered for members receiving nebulized medications for a variety of respiratory or pulmonary conditions and diseases and other serious conditions.

Ultrasonic or electric aerosol generators with small-volume nebulizers (E0574) are covered for members with cystic fibrosis or other serious conditions receiving Tobramycin or for members with pulmonary artery hypertension receiving Treprostinil inhalation solution.

Large-volume ultrasonic nebulizers (E0575) are covered for members with cystic fibrosis or other serious conditions receiving Tobramycin. Authorization is always required.

Reservoir bottles (A7009) and dome and mouthpieces (A7016) are only covered for members with cystic fibrosis or other serious conditions requiring delivery of medically necessary Tobramycin. Ultrasonic nebulizers and associated supplies are not covered for members with other diagnoses because there is no proven medical benefit to nebulizing particles of other drugs to diameters smaller than achievable with a pneumatic model.

Included with initial dispensing:

· Compressor

· Mask

· Mouthpiece

· Reusable nebulizer

· Tubing

Separately billable after initial dispensing:

· Disposable mouthpieces

· Face mask

· Replacement of disposable handheld nebulizer

· Replacement tubing

Nebulizer Supply Codes
A7003	A7007	A7011	A7015
A7004	A7008	A7012	A7016
A7005	A7009	A7013	A7017
A7006	A7010	A7014	A7018

Refer to the Medical Supply Coverage Guide for coverage information and limits on supplies.

Authorization

Authorization is required for the following:

· Quantities over MHCP quantity limits

· Ultrasonic, large-volume nebulizers (E0575)

Submit authorization request and required documentation to the Medical Review Agent.

Documentation for ultrasonic, large-volume nebulizers must include:

· Member’s diagnosis; and

· Order for Tobramycin; and

· Documentation explaining why other nebulizers do not satisfy the member’s needs; and

· Consideration of less costly alternatives.

Billing

Providers are responsible to coordinate services. Review Billing Policy Overview for general billing information.

Bill nebulizers using MN–ITS 837P Professional. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics and Orthotics, and Augmentative Devices MN–ITS user manual for general billing requirements and guidance when submitting claims.

· Use modifier NU for purchases.

· Use modifier RR for rentals.

· Use modifiers KH, KI, KJ, and RR as appropriate for capped rentals.

· Enter the ordering provider in the Other Provider Types section of the Provider tab of the MN–ITS Interactive Claim.

Documentation must include:

· Member’s diagnosis; and

· Medications prescribed; and

· Frequency of administration; and

· Consideration of less costly alternatives.

Large-volume ultrasonic nebulizers are capped rental items only. Dispensing of rentals includes education on use of the equipment and routine servicing and repairs to make the nebulizer functional.

Supplies for nebulizers are purchase-only items.