Nebulizer Use in Home (Adult & Pediatric)
DESCRIPTION
A nebulizer is a device used to change liquid medication to an aerosol particulate (mist) form. The size of particulate the nebulizer produces is measured as mass median aerodynamic diameter (MMAD) in terms of microns. How rapidly the nebulizer distributes the medication is measured in terms of particulate size distribution.
A nebulizer is used when there is the need to deliver a topical medication (in aerosol form) that has its site of action in the airway or is intended for systemic absorption. Such medications may possibly include antibiotics, bronchodilators, anti-inflammatory agents, antivirals, antifungals, surfactants, and enzymes.
Nebulizers are powered by compressed gas from electrically driven compressors, compressed gas cylinders, or the vibrations of a piezoelectric crystal. The physician prescribed amount of liquid medication is placed into the nebulizer cup. Saline is often added to the nebulizer cup. The saline leads to an increase in the amount of the medication that is nebulized. The aerosol is delivered over a period of 5 to 15 minutes by mouthpiece or mask.
A nebulizer can also be used to deliver humidification. Sterile water or saline (hypotonic, isotonic, or hypertonic) is used in the nebulizer for delivery in aerosol form for this purpose. This technique is referred to as bland aerosol administration.
POLICY
Nebulizer use in the home to deliver prescription medication is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Nebulizer use in the home to deliver humidification (bland aerosol administration) is considered investigational.
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
MEDICAL APPROPRIATENESS
Nebulizer use in the home is considered medically appropriate if ALL the following criteria are met:
Use of the is restricted to delivering prescription medication
Prescribed medication can be administered by nebulization
Inability of the individual to use a multidose inhaler (MDI) for medication administration due to lack of coordination or lack of cooperation
Confirmed diagnosis with ANY ONE of the following conditions:
Asthma
Cystic fibrosis (CF)
Chronic Obstructive Pulmonary Disease (COPD)
Bronchitis
Pneumocystis carinii pneumonia
Other reversible obstructive airway disease
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The pediatric population with croup and acute laryngeal obstruction is often treated in the MD office or emergency dept./hospital with a nebulized saline solution. This setting (MD office or emergency department/hospital) allows for continued observation and treatment.
The individual for whom the nebulizer is ordered and/or caregiver should demonstrate proper technique and compliance with the application of the aerosol delivery system.
The nebulizer should be cleaned per MD or home care supplier instruction after each use to prevent an infection. Cleaning the nebulizer also keeps it from clogging and helps it last longer.
Exposure to prescription medication should be limited per manufacturer instructions to the individual for whom it has been ordered.
Any device utilized for this procedure must have FDA approval specific to the indication. Treatment with a nebulizer is categorized as durable medical equipment by BCBST.
In the absence of any well-designed randomized controlled trials, no conclusions can be drawn about whether the use of a nebulizer in the home to deliver bland aerosol administration has an effect on health outcomes.
SOURCES
American Association of Respiratory Care (AARC). (1996, July). AARC Clinical practice guideline: Selection of a device for delivery of aerosol to the lung parenchyma. Respiratory Care, 41 (7), 647-653. Retrieved December 4, 2008 from http://www.rcjournal.com/cpgs/dalpcpg.html. (62 articles and/or guidelines reviewed)
American Association of Respiratory Care (AARC). (2002). Clinical practice guideline: Selection of an aerosol delivery device for neonatal and pediatric patients. Respiratory Care, 47 (6), 707-716. (114 articles and/or guidelines reviewed)
American Association of Respiratory Care (AARC). (2003, May). Clinical practice guideline: Bland aerosol administration. Respiratory Care, 48 (5), 529-533. (23 articles and/or guidelines reviewed)
Complete Guide to Medicare Coverage Issues [Computer software]. (2011, August). Nebulized beta adrenergic agonist therapy for lung diseases (NCD 200,2, p. 2-164 thru 2-165). Ingenix.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). (2010). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Retrieved September 6, 2011 from http://www.goldcopd.org/. (462 articles and/or guidelines reviewed)
National Institutes of Health (NIH). National Heart, Lung and Blood Institute. (2007). National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the diagnosis and management of asthma. Retrieved November 25, 2008 from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf. (over 100 articles and/or guidelines reviewed)
ORIGINAL EFFECTIVE DATE: 4/1/2001
MOST RECENT REVIEW DATE: 11/10/2011
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.