Nebulizer compressors, accessories, and associated medications are covered benefits for Medicaid and Health and Recovery Plan (HARP) members. The charts below provide information on items covered by EmblemHealth and those covered through pharmacies enrolled in the New York State Medicaid Pharmacy program (NYRx) or Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) providers.
EmblemHealth covers the following items for Medicaid and HARP members when supplied by an in-network provider. These items should be billed to EmblemHealth:
| Item | Available From | Responsible Party | Drug and/or Supply Codes NDC or HCPCS |
|---|---|---|---|
| Nebulizer (with compressor) | DMEPOS provider | EmblemHealth | E0570F6
|
Nebulizer (ultrasonic, large volume) | DMEPOS provider | EmblemHealth | E0575F3 |
30-day rental: Stationary compressed gaseous oxygen system rental includes: container, contents, regulatory, flowmeter, humidifier, nebulizer, cannula, or mask and tubing | DMEPOS provider | EmblemHealth | E0424F26 |
The following items are covered by New York State Medicaid fee-for-service and must be billed to NYRx:
| Item | Available From* | Responsible Party | Drug and/or Supply Codes NDC or HCPCS |
|---|---|---|---|
| Medication used within the nebulizer | Pharmacy | NYRx | NYRx List of reimbursable drugs |
| Aerosol mask, used with DME nebulizer | Pharmacy or DMEPOS provider | NYRx, DMEPOS | A7015F8 |
| Holding chamber or spacer for use with an inhaler or nebulizer, with a mask | Pharmacy or DMEPOS provider | NYRx, DMEPOS | S8100F21 S8101F21 |
| Administration kit, with small volume non-filtered pneumatic nebulizer, non-disposable | Pharmacy or DMEPOS provider | NYRx, DMEPOS | A7005F7 |
| Administration kit, with small volume non-filtered pneumatic nebulizer, disposable | Pharmacy or DMEPOS provider | NYRx, DMEPOS | A7003 |
| Small volume nonfiltered pneumatic nebulizer, disposable | Pharmacy or DMEPOS provider | NYRx, DMEPOS | A7004 |
| Large volume nebulizer, disposable, unfilled, used with aerosol compressor | Pharmacy or DMEPOS provider | NYRx, DMEPOS | A7007 |
*To locate a NYRx-enrolled pharmacy or DMEPOS provider, visit the pharmacy or medical equipment supplier look-up tool (which is the same one that members use).
For more information and resources, view the NYRx and NYS Medicaid DMEPOS Nebulizers document.
JP 64624 5/2024