Spirometers

Revised: July 27, 2026

· Overview

· Eligible Providers

· TPL and Medicare

· Eligible Members

· Covered 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 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 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

Spirometers are covered for eligible Medical Assistance and MinnesotaCare members for home monitoring of respiratory or cardiovascular conditions.

Covered Services

Codes: A9284, E0487
MHCP covers the following spirometer equipment:

· Spirometer, nonelectronic, includes all accessories (A9284)

· Spirometer, electronic, includes all accessories (E0487)

Spirometers are covered for members who require home monitoring of respiratory or cardiovascular conditions. Documentation must include the member’s diagnosis and medical necessity for respiratory or cardiovascular monitoring.

Spirometers may be electronic or nonelectronic. Electronic spirometers are covered when the member’s medical needs cannot be satisfied with a nonelectronic spirometer. Documentation must clearly articulate why nonelectric spirometers do not satisfy the needs of the member.

Only spirometers approved by the U.S. Food and Drug Administration are covered.

Authorization

Authorization is required for the following:

· Quantities over MHCP quantity limits

· HCPCS codes without an MHCP fee schedule rate always require authorization if the submitted charge is over $400

Submit authorization to the Medical Review Agent.

Providers must include a respiratory or cardiovascular condition statement detailing medical need for home monitoring, including specific patient orders. Document medical necessity for electronic spirometers when nonelectric spirometers do not satisfy the needs of the member.

Billing

Providers are responsible to coordinate services. Refer to the Billing Policy Overview section of Provider Basics for general billing information.

Bill spirometers 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 claim instructions.

· Use modifier NU for purchases.

· Use modifier RR for rentals.

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

· If the member has Medicare, MHCP will pay only the deductible or coinsurance on any item for which Medicare made payment, regardless of any MHCP prior authorization.

· When billing for items approved on a prior authorization, make sure the HCPCS codes, modifiers and descriptions on the claim match the same information on the prior authorization. Enter the authorization number in the authorization field for each line.

· Submit the usual and customary charge for each line, not the approved amount from the authorization letter. Payment will be the balance of the lesser of the billed amount or the approved amount after any primary or secondary payers have made payment.

Spirometers may be purchased or rented. Dispensing of spirometer includes all accessories and education on use of equipment.