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JURISDICTION DME MAC/DMERC PHONE NUMBER Jurisdiction A National Heritage Insurance Co. Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New York, New Hampshire, New Jersey, Pennsylvania, Rhode Island and Vermont DME - Specialty Claims P.O. Box 9165 Hingham, MA www.medicarenhic.com IVR: (866) 419-9458. In the new guidance, suppliers are directed to fill and submit the Reopening Request forms available on the DME MAC websites. Suppliers need to fax the completed forms to the appropriate DME MAC fax numbers that is listed at the bottom of the form. CMS published the following instructions on filling out the forms.
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Noridian DME Jurisdiction D
PDF download:
www.cms.gov
(DME MAC). Contract for Jurisdiction D. ▫ On September 10, 2015, the Centers for
Medicare & Medicaid Services (CMS) awarded Noridian Healthcare Solutions, …
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JA awarded to Noridian December 2015; implementation in progress. * JB
awarded to CGS in September 2015; implementation in progress. DME
Jurisdiction …
www.cms.gov
Jan 15, 2016 … Durable Medical Equipment (DME) Medicare Administrative Contractor (MAC)
Jurisdiction D contract to. Noridian Healthcare Solutions, LLC for …
oig.hhs.gov
Sep 9, 2010 … equipment Medicare administrative contractor for Jurisdiction D, within 5 …. CMS
awarded the DME MAC contract for Jurisdiction D to Noridian.
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As of January 2016. MAC. Jurisdiction … (awarded to Noridian Dec 2015;
implementation in progress). DME B. DME B. Illinois, Indiana … DME D. Alaska,
Arizona, California, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana,. Nebraska,
Nevada …
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Feb 4, 2011 … Jurisdiction D. We will forward a copy of this report to the HHS action …. Noridian
Administrative Services, LLC (Noridian), the DME MAC for …
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monthly rental payments for this category of DME as long as medical necessity
and Part B coverage ….. 6 Noridian Healthcare Solutions, Ventilators (HCPCS
E0464) Quarterly … Respiratory Assist Devices (L33800) for DME MAC
Jurisdictions A, B, C, and. D, available at https://www.cms.gov/medicare-
coverage-database/.
www.doh.wa.gov
Jun 30, 2013 … We'd like to thank you for joining us for this training on Medicare for Washington
State … Jurisdiction Immunization Billing Resource Guide.
www.justice.gov
Sep 2, 2015 … Defendants also fraudulently dispensed DME, in the form of sleep … This Court
may exercise personal jurisdiction over Qualium Corporation d/b/a ….. Noridian
Healthcare Solutions, LLC (“Noridian”) has been the MAC …
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When submitting claims to DME MACs, suppliers use Healthcare Common …..
Noridian is the DME MAC for Medicare DME Jurisdiction D. Ninety percent of the
…
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Coverage for Small-Volume Nebulizers
HMSA and Health Plan Hawaii plans cover the purchase of small volume nebulizers when the criteria listed below are met. For large-volume nebulizers, only the rental of the equipment is covered. The criteria for coverage of large-volume nebulizers are as stated in the DME MAC Jurisdiction D Supplier Manual.
Note: This policy does not apply to HMSA's Medicare-based plans (HMSA Akamai Advantage® ). For HMSA's Medicare-based plans, please refer to the Nebulizer LCD listed in Noridian Medicare.
General Information
Nebulizer is a common name that is applied to several pieces of equipment used together to achieve nebulization of liquid into a fine spray. A nebulizer is made up of the following parts.
- Compressor - a device used to nebulize liquid by means of high-pressure air flow, or
- Generator - a device used to nebulize liquid by means of ultrasonic vibrations, and
- Nebulizer - the mouthpiece or chamber in which nebulization
- Accessories - including tubing and filters
Small-volume nebulizers are units designed for home care or care in other outpatient settings. They have a maximum capacity of 10-15 mL. The criteria below apply to the administration of medication using a small-volume nebulizer for the treatment of pulmonary disease and not for the use of large-volume nebulizers or humidifiers for mechanical ventilators or for patients with artificial airways.
Clinical Indications for the Coverage of Small-Volume Nebulizers
Small-volume nebulizers will be covered in lieu of metered dose inhalers (MDI) or dry powder inhalers (DPI) if one or more of the following conditions applies:
- After instruction by the physician or the physician's staff, the patient is judged incapable of using an inhaler correctly. If patient coordination is a problem or if inhaled corticosteroids are being used, instruction should incorporate the use of an auxiliary device, such as a reservoir chamber or mask. Factors that might cause the physician to judge the patient incapable of using an inhaler are:
- Physical inability to carry out the required maneuver
- Cognitive inability to comprehend instructions for the use of the inhaler
- Age (children ages 11 and younger)
- For adults, spirometric testing shows that the inspired vital capacity is less than one and a half times the predicted tidal volume of 7 mL/kg, or the inspired flow is less than 30 L/min, or the breath hold capacity is less than 4 seconds.
- The patient has tried using an MDI, but the therapy has proven to be clinically suboptimal and MDI dosage and compliance have been assessed and cannot be enhanced.
Note: A small-volume nebulizer will also be covered if a patient demonstrates recurrent episodes of acute airflow obstruction or decompensation that compromises his or her ability to use a MDI or renders inhaler therapy ineffective, even when used with a reservoir chamber or mask.
Examples of such episodes might include allergen exposure, infection, or acute episodes of bronchospasm. In these situations, a small-volume nebulizer should be used during the decompensation period. Inhaler therapy may be resumed when the patient's condition is stable.
Battery-Powered Compressor
A battery-powered compressor (HCPCS code E0571) is rarely medically necessary. If this compressor is provided without accompanying documentation that meets medical necessity criteria and the coverage criteria for code E0570 are met, payment will be based on the allowance for the least costly medically acceptable alternative (HCPCS code E0570).
Covered Diagnosis Codes
The following ICD-9-CM diagnoses are appropriate diagnoses for small-volume nebulizer usage if the previously listed criteria are met:
| ICD-9 | Description | ICD-10 | Description |
| 042 | Human immunodeficiency virus [HIV] | B20 | Human immunodeficiency virus [HIV] disease |
| 136.3 | Pneumocystosis | B59 | Pneumocystosis |
| 277.00-277.01 | Cystic fibrosis | E84.11 E84.9 | Meconium ileus in cystic fibrosis Cystic fibrosis, unspecified |
| 466.11-466.19 | Acute bronchiolitis | J21.0-J21.9 | Acute bronchiolitis |
| 480.1 | Pneumonia due to respiratory syncytial virus | J12.1 | Respiratory syncytial virus pneumonia |
| 491.0-491.9 | Chronic bronchitis | J41.0 J42 J44.0-J44.9 | Simple and mucopurulent chronic bronchitis Unspecified chronic bronchitis Other chronic obstructive pulmonary disease |
| 492.0-492.8 | Emphysema | J43.0-J43.9 | Emphysema |
| 493.00-493.92 | Asthma | J44.0-J44.9 J45.20-J45.998 | Other chronic obstructive pulmonary disease Asthma |
| 504 | Pneumonopathy due to inhalation of other dust | J66.0-J66.8 | Airway disease due to specific organic dust |
| 505 | Pneumoconiosis, unspecified | J64 J65 | Unspecified pneumoconiosis Pneumoconiosis associated with tuberculosis |
| 516.1-516.9 | Other alveolar and parietoalveolar pneumonopathy | J84.02 J84.03 J84.09 J84.111-J84.117 J84.2 J84.81 J84.82 J84.83 J84.841 J84.842 J84.843 J84.848 J84.9 J99 | Pulmonary alveolar microlithiasis Idiopathic pulmonary hemosiderosis Other alveolar and parieto-alveolar conditions Idiopathic interstitial pneumonia Lympoid interstitial pneumonia Lymphangioleiomyomatosis Adult pulmonary Langerhans cell histiocytosis Surfactant mutations of the lung Neuroendocrine cell hyperplasia of infancy Pulmonary interstitial glycogenosis Alveolar capillary dysplasia with vein misalignment Other interstitial lung diseases of childhood Interstitial pulmonary disease, unspecified Respiratory disorders in diseases classified elsewhere |
| 517.1-517.8 | Lung involvement in conditions classified elsewhere | D57.01 D57.211 D57.411 D57.811 J17 J99 M32.13 M33.01 M33.11 M33.21 M33.91 M34.81 M35.02 | Hb-SS disease with acute chest syndrome Sickle-cell/Hb-C disease with acute chest syndrome Sickle-cell thalassemia with acute chest syndrome Other sickle-cell disorders with acute chest syndrome Pneumonia in diseases classified elsewhere Respiratory disorders in diseases classified elsewhere Lung involvement in systemic lupus erythematosus Juvenile dermatopolymyositis with respiratory involvement Other dermatopolymyositis with respiratory involvement Polymyositis with respiratory involvement Dermatopolymyositis, unspecified with respiratory involvement Systemic sclerosis with lung involvement Sicca syndrome with lung involvement |
| 748.61 | Congenital bronchiectasis | Q33.4 | Congenital bronchiectasis |
| 770.7 | Chronic respiratory disease arising in the perinatal period (e.g., bronchopulmonary dysplasia) | P27.0-P27.9 | Chronic respiratory disease originating in the perinatal period |
| 786.2 | Cough, intractable | R05 | Cough |
| 786.4 | Abnormal sputum (persistent thick or tenacious pulmonary secretions) | R09.3 | Abnormal sputum |
Documentation Requirements
The patient's medical record should include the clinical indications for small-volume nebulizer use. The record should be made available for review upon request.
Replacement Guidelines
HMSA will follow the guidelines for replacement of small-volume nebulizer accessories as shown in the DME MAC Jurisdiction D Supplier Manual.
Benefit Limitations
Jurisdiction D Dme Mac Supplier Manual Instructions
Many HMSA plans include an annual deductible for durable medical equipment. The deductibles generally range for $100 to $250 per calendar year. Even though HMSA may allow benefit coverage for small-volume nebulizers under this policy, if the patient's deductible for the calendar year has not been met, HMSA's allowance will be applied to the deductible and the member will be responsible to pay for the device as an out-of-pocket expense.