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October 29, 2015

TOBI® Podhaler™ - Correct Coding

Joint DME MAC Publication

The TOBI® Podhaler™ (Novartis) is a disposable, hand-held medication dispenser used for the inhalation of tobramycin. This device is not a hand-held nebulizer with a pneumatic compressor and thus is not eligible for reimbursement under the Medicare Durable Medical Equipment Benefit. The TOBI® Podhaler™ is provided as a complete system that includes both the inhaler and tobramycin capsules. Claims for the TOBI® Podhaler™ billed to the DME MAC must be coded with HCPCS code A9270 (Noncovered item or service) and will be denied as statutorily non-covered (no benefit).

HCPCS Code J7682 (Tobramycin, Inhalation Solution, FDA-Approved Final Product, Non-Compounded, Unit Dose Form, Administered Through DME, Per 300 Milligrams) must not be used to bill separately for the tobramycin capsules provided for use in a TOBIĀ® Podhaler™. Separate billing for the TOBI® Podhaler™ device and tobramycin capsules will be denied as unbundling.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC websiteExternal website.

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