1. Medically necessary to administer beta-adrenergics, anticholinergics, corticosteroids and cromolyn for the management of obstructive pulmonary disease (ICD-9-CM codes 491.0-505), or
2. Medically necessary to administer gentamicin, tobramycin, amikacin, or dornase alpha to a patient with cystic fibrosis (ICD-9-CM code 277.0), or
3. Medically necessary to administer pentamidine to patients with HIV (ICD-9-CM code 042), pneumocystosis (ICD-9-CM 136.3) and complications of organ transplants (ICD-9-CM codes 996.8 - 996.89), or
4. Medically necessary to administer mucolytics (other than dornase alpha) for persistent thick or tenacious pulmonary secretions (ICD-9-CM codes 480.0 - 505 and 786.4).

Use of inhalation drugs, other than those listed above, will be denied as not medically necessary.

For criterion (a) to be met, the physician must have considered the use of a metered-dose inhaler (MDI) with and without a reservoir or spacer device and decided that, for medical reasons, it was not sufficient for the administration of needed inhalation drugs. The reason for requiring a small volume nebulizer and related compressor/generator instead of or in addition to an MDI must be documented in the patient's medical record and be available to the DMERC on request. (If none of the drugs used with a nebulizer are covered, the nebulizer and its accessories/supplies will be denied as not medically necessary.)