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Issue Number - Name
0025 - Nebulizers Billed With Diagnosis Codes Other Than Those Listed in Local Coverage Determination
Review Type
Claim Type
DME Supplier
Region and State
All States
Date Approved


Overpayments were identified where diagnosis codes were not in accordance with billing requirements outlined in Local Coverage Determinations for Nebulizers, Related Drugs, and Accessories.

Affected Codes

  • A4216, A4217, A4619, A7003, A7004, A7005, A7006, A7007, A7010, A7011, A7012, A7013, A7014, A7015, A7016, A7017, A7018, A7525, E0565, E0570, E0572, E0574, E0585, E1372, J2545, J7605, J7606, J7608, J7611, J7612, J7613, J7614, J7620, J7626, J7631, J7639, J7644, J7669, J7682, J7686, K0730, Q0474

Applicable Policy References

  • LCD Nationwide, L33370, Effective 10/1/2015 
  • 42 Code of Federal Regulations, 405.986 
  • 42 Code of Federal Regulations, 405.980 
  • CGS LCD, L5007, Retired 9/30/2015
  • NGS LCD, L27226, Retired 9/30/2015
  • NHIC LCD, L11499, Retired 9/30/2015
  • Noridian LCD, L11488, Retired 9/30/2015