Spirometers

Revised: December 12, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Authorization

· Billing

Overview

Spirometers are pulmonary function tests used to measure the volume or flow of inhaled and exhaled air.

Eligible Providers

The following providers may provide spirometers:

· Federally qualified health centers

· Home health agencies

· 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 Medicare. This is to help members for whom Minnesota Health Care Programs (MHCP) is not the primary payer.

Eligible Members

Spirometers are covered for MHCP members when medically necessary for home monitoring of respiratory or cardiovascular conditions.

Covered Services

Codes: A9284 (non-electronic), E0487 (electronic)
Only spirometers approved by the U.S. Food and Drug Administration are covered.

Authorization

Authorization is required when the cost of the spirometer is more than $400. All authorization requests must include a respiratory or cardiovascular condition statement detailing medical need for home monitoring, including specific patient orders. A request for an electronic spirometer additionally requires an explanation of why a nonelectronic spirometer will not meet the member’s needs.

Submit the authorization request and required documentation to the authorization medical review agent.

Billing

When billing with an approved authorization:

· Bill electronically using MN–ITS 837P Professional format

· Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics and Orthotics, and Augmentative Devices MN–ITS User Guide for detailed instructions

· Enter the ordering provider’s NPI or UMPI as the Ordering Provider in MN–ITS

· Use the correct HCPCS code and the modifier NU or RR as noted on the authorization

Refer to the Billing and the Orders subsections of the Equipment and Supplies MHCP Provider Manual section for more information.