The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have issued a reminder about coverage of drugs linked to nebulizer (HCPCS code L33370) and external infusion pump (L33794) local coverage determinations (LCDs).
In a Jan. 23 joint publication, the DME MACs said, “Suppliers are reminded that while these LCDs are often thought of as a drug coverage policy, the benefit is durable medical equipment, and the inhaled or infused drug is considered as a supply to the DME. Consequently, the overarching coverage requirement is that administration of the drug via a nebulizer or external infusion pump must be reasonable and necessary. The NEB [nebulizer] and EIP [external infusion pump] LCDs outline the coverage criteria for specific drugs or classes of drugs that meet the requirements for coverage.”
The DME MACs said the reminder was in response to recent supplier questions about Medicare coverage for drugs under the nebulizer and external infusion pump LCDs.
“Coverage details for newly approved drugs will not initially be available within the LCDs until a reconsideration is completed and evaluated by the DME MACs,” the reminder added. “In such situations, claims for drugs are processed on a claim-by-claim basis.”
