23 Miss. Code. R. 209-1.33 - Nebulizer

A. Medicaid defines a nebulizer as an apparatus for producing a fine spray or mist primarily for use in administering drugs by inhalation.

1. This may be accomplished by rapidly passing air through a liquid or by vibrating a liquid at a high frequency so that the particles produced are extremely small.

2. Medicaid expects that the practitioner will have considered the use of a metered dose inhaler with and without a reservoir or spacer device, if age appropriate, and has determined that, for medical reasons, it was not sufficient for the administration of needed inhalation drugs.

B. Medicaid covers nebulizers for all beneficiaries when prior authorized by the Utilization Management and Quality Improvement Organization (UM/QIO), the Division of Medicaid or designated entity, for rental up to purchase amount, or purchase when indicated and ordered by a physician as follows:

1. A nebulizer is covered for rental only when a beneficiary has an acute condition, such as pneumonia or acute bronchitis, which is expected to resolve in a short time.

2. A nebulizer is covered for purchase when a beneficiary has a chronic condition that is not expected to resolve in a short time or is expected to recur frequently. Medical conditions that may be chronic or long term, but are not limited to:

a) Chronic bronchitis,

b) Cystic fibrosis,

c) Asthma,

d) Diaphragmatic hernia,

e) Congenital heart anomaly,

f) Respiratory distress syndrome,

g) Chronic obstructive pulmonary disease, and

h) Bronchopulmonary dysplasia.

Notes

23 Miss. Code. R. 209-1.33

42U.S.C. § 1395m; Miss. Code Ann. §§ 43-13-117(17); 43-13-121.

Amended 9/1/2018