CMS Issues Draft Local Coverage Determination for Nebulizers

BALTIMORE–CMS released a draft local coverage determination
last week that would revise the current nebulizer coverage policy.
According to the DME Program Safeguard Contractors, the proposed
changes include:

–Payment for levalbuterol will be based on the allowance for
albuterol;
–Payment for DuoNeb will be based on the allowance for separate
unit dose vials of albuterol and ipratropium;
–Coverage for the following nebulizer drugs is eliminated because
there is inadequate support in the medical literature for
administration using a DME nebulizer: amikacin, atropine,
beclomethasone, betamethasone, bitolerol, dexamethasone,
flunisolide, formoterol, gentamicin, glycopyrrolate, terbutaline
and triamcinalone. Coverage will therefore be limited to these
drugs: acetylcysteine, albuterol, budesonide, cromolyn, dornase
alpha, iloprost, ipratropium, isoetharine, isoproterenol,
levalbuterol, metaproterenol, pentamidine, and tobramycin;
–Maximum milligrams/month for budesonide are defined.

The deadline to submit comments on the LCD is May 8.

A March 24 bulletin from DMERC A/B advises: “If you disagree
with any aspect of these four changes, you should be very specific
and, if possible, offer an alternative indication, guideline, etc.
You should provide a clinical rationale for your position including
references from the published clinical literature (e.g. standard
textbooks, peer-reviewed journals, etc.). We would also encourage a
written response if you agree with these changes in the
policy.”

Comments should be submitted to each DME PSC medical director by
snail mail or via e-mail through each DME PSC’s Web site. In
addition, suppliers are invited to attend an upcoming meeting,
which will be held by each of the three PSCs, to receive comments
on the draft policy.

To contact your PSC, visit:
–Region A/B, Tricenturion, www.tricenturion.com;
–Region C, TrustSolutions, LLC, www.trustsolutionsllc.com;
or
–Region D, EDS, www.edssafeguardservices.eds-gov.com.

To view a copy of the draft LCD,
click here.