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Nebulizer Drugs Units of Service

The DME MAC are aware of trends in billing discrepancies for nebulizer drugs. This article serves as a tool to assist DMEPOS suppliers to correctly calculate the UOS for nebulizer drugs when billing.

Drug Name HCPCS UOS Maximum/month Maximum UOSmonth
Acetylcysteine J7608 per 1 gram 74 grams/month 74
Albuterol J7611, J7613 per 1 mg 465 mg/month** 465
Albuterol/Ipratropium combination J7620 up to 2.5 mg albuterol and   0.5 mg of ipratropium - 3.0mg total – 1 vial 558 mg total/month – 186 vials** 186
Arformoterol J7605 15 mcg 930 mcg/month 62
Budesonide J7626 up to 0.5 mg – 1 vial 31 mg/month 62
Cromolyn sodium J7631 per 10 mg 2480 mg/month 248
Dornase alpha J7639 per 1 mg 78 mg/month 78
Formoterol J7606 20 mcg 1240 mcg/month 62
Ipratropium bromide J7644 per 1 mg 93 mg/month 93
Levalbuterol J7612, J7614 per 0.5 mg 232.5 mg/month ** 465
Metaproterenol J7669 per 10 mg 2800 mg/month ** 280
Pentamidine J2545 per 300 mg 300 mg/month 1
Treprostinil J7686 1.74 mg – 1 ampule/vial 31 ampules/vials month 31
Sterile saline or water A4216, A4218 10 ml – 1 unit 560 ml/month 56
Distilled water, sterile water, or sterile saline in large volume nebulizer A4217, A7018 500 ml 18,000 ml – 18 liters/month 36

**When albuterol, levalbuterol, or metaproterenol are prescribed as rescue/supplemental medication for patients who are taking formoterol or arformoterol, the maximum milligrams/month that are reasonably billed are:

Drug Name HCPCS Unit of Service (UOS) Maximum/month Maximum UOSmonth
Albuterol J7611, J7613 1 mg 78 mg/month 78
Albuterol/Ipratropium combination J7620 up to 2.5 mg albuterol and 0.5 mg of ipratropium  – 3.0 mg total – 1 vial 93 mg/month – 31 vials 31
Levalbuterol J7612, J7614 0.5 mg 39 mg/month 78
Metaproterenol J7669 Per 10 mg 470 mg/month 47

The billing unit of service for inhalation drug codes varies. Suppliers must be sure that they use the correct billing unit of the code when calculating the number of units of service to enter on the claim. Listed below are examples of some of the more common errors identified when billing for nebulizer drugs:

  1. Code J7620 is used for a FDA-approved combination of albuterol and ipratropium which contains 3.0 mg of albuterol sulfate, which is 2.5 mg of albuterol base and 0.5 mg of ipratropium bromide in each unit dose vial. For these products, 1 unit of service of J7620 equals 1 unit dose vial.
  2. For code J7626 and J7627 (budesonide, unit dose) bill one unit of service for each vial dispensed, regardless of whether a 0.25 mg vial or a 0.5 mg vial is dispensed. If the vial dispensed is a 1.0 mg vial suppliers must bill 2 units of service for each vial dispensed.

For additional information, suppliers should refer to the nebulizers local coverage determination and policy article.

Nebulizer Drugs Units of Service
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