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Fact Sheet

Nebulizer Drugs: Dispensing Fees Fact Sheet

This fact sheet provides guidance for billing dispensing fees for Nebulizer drugs.

Dispensing Fee HCPCS Codes

HCPCS Descriptor
G0333 Pharmacy dispensing fee for inhalation drug(s); initial 30-day supply as a beneficiary
Q0513 Pharmacy dispensing fee for inhalation drug(s); per 30 days
Q0514 Pharmacy dispensing fee for inhalation drug(s); per 90 days

Billing Rules

  • Bill dispensing fees only when the drug is covered under the Nebulizers Local Coverage Determination (LCD).
  • Bill the dispensing fee on the same claim as the drug. If you submit the dispensing fee separately, Medicare will deny the dispensing fee for incorrect billing.
  • Bill the dispensing fee with the appropriate modifier (KX, GA, or GZ modifier).
  • Medicare will not pay for a separate dispensing fee for saline.
    • This doesn't apply to hypertonic saline (J7131), which is administered as an inhalation drug and not as a diluent.
  • Medicare will not pay a separate fee for the compounding of inhalation drugs.

Units of Service

  • Medicare only pays 1 dispensing fee in a 30-day or 90-day period.
    • This rule applies no matter how many drugs are dispensed, how many shipments are made, or how many pharmacies the beneficiary uses during this time.
  • For refills, Medicare won't pay a dispensing fee any sooner than 10 days before the end of usage for the current 30-day or 90-day period.
  • Medicare won't pay more than 12 months of dispensing fees per patient per 12-month period.
  • If you bill a dispensing fee too soon, Medicare will deny the claim as not separately payable.
  • G0333
    • Medicare will pay the G0333 to one pharmacy for the initial 30-day supply of covered inhalation drugs.
      • This rule applies no matter how many drugs are dispensed, how many shipments are made, or how many pharmacies the beneficiary visits during that time.
    • Medicare will pay for G0333 only once in a lifetime.
      • This only applies to patients who are using inhalation drugs for the first time as a Medicare beneficiary on or after 01/01/2006.
    • If you bill G0333 and it's not for the initial 30-day supply, Medicare will deny the claim as incorrect billing.
  • Q0513 & Q0514
    • After you bill G0333 once for a patient, bill code Q0513 for the 30-day dispensing fee or Q0514 for the 90-day dispensing fee on all future claims.
    • Medicare will not pay for Q0513 and Q0514 on the same date of service.
      • If you dispense a 90-day supply of one drug, and a 30-day supply of another drug on the same day, bill Q0514.

Tips to Avoid Common Errors

  • Incorrect HCPCS Billed
    • HCPCS codes must match the service you provide.
      • G0333 is only for the first drug dispensed in a patient's lifetime.
      • Use Q0513 if you are dispensing a 30-day supply of inhalation drugs.
      • Use Q0514 if you are dispensing a 90-day supply of inhalation drugs.
  • Multiple Dispensing Fees
    • If you bill more than 1 dispensing fee in a 30-day or 90-day period, Medicare will deny the fee as not separately payable.
  • Related Drugs Not Included
    • Bill the dispensing fee on the same claim as the drug code.
  • Non-covered
    • If Medicare denies a drug as non-covered, Medicare will also deny the dispensing fee as non-covered.
  • How to Prevent Duplicate Denials
    • Use the myCGS® Web PortalExternal Website to check claim history to see which dispensing fees were already billed.

Resources

Published: 02.19.2026

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