LCD/NCD Portal

NCD200.2 NEBULIZED BETA ADRENERGIC AGONIST THERAPY FOR LUNG DISEASES

 

Effective Date of this Version

1/22/2008

 

Benefit Category

• Durable Medical Equipment

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Item/Service Description

 

General

• Lung diseases such as chronic obstructive pulmonary disease (COPD) and asthma are characterized by airflow limitation that may be partially or completely reversible.

o Pharmacologic treatment with bronchodilators is used to prevent and/or control daily symptoms that may cause disability for persons with these diseases.

o These medications are intended to improve the movement of air into and from the lungs by relaxing and dilating the bronchial passageways.

o Beta adrenergic agonists are a commonly prescribed class of bronchodilator drug.

o They can be administered via nebulizer, metered dose inhaler, orally, or dry powdered inhaler.

• Nebulized beta adrenergic agonist with racemic albuterol has been used for many years.

o More recently, levalbuterol, the (R) enantiomer of racemic albuterol, has been used in some patient populations.

o There are concerns regarding the appropriate use of nebulized beta adrenergic agonist therapy for lung disease.

 

Indications and Limitations of Coverage

 

Nationally Covered Indications

N/A

 

Nationally Non-Covered Indications

N/A

 

Other

• After examining the available medical evidence, the Centers for Medicare & Medicaid determines that NO national coverage determination (NCD) is appropriate at this time. Section 1862(a)(1)(A) of the Social Security Act decisions should be made by local contractors through a local coverage determination process or case-by-case adjudication. See Heckler v. Ringer, 466 U.S. 602, 617 (1984)

• (Recognizing that the Secretary has discretion to either establish a generally applicable rule or to allow individual adjudication.). See also, 68 Fed. Reg. 63692, 63693 (November 7, 2003).

• (This NCD last reviewed September 2007.)

 

Coverage Transmittal Link

• http://www.cms.gov/transmittals/downloads/R79NCD.pdf

 

National Coverage Analyses (NCAs)

• This NCD has been or is currently being reviewed under the National Coverage Determination process.

• The following are existing associations with NCAs, from the National Coverage Analyses database.

• Original consideration for Nebulized Beta Adrenergic Agonist Therapy for Lung Diseases (CAG-00354N)

 

 

Medicare NCD Link