Summary & Overview
HCPCS J7613: Albuterol Inhalation Solution via DME, Unit Dose, 1 mg
HCPCS Level II code J7613 identifies a single-dose, FDA-approved albuterol inhalation solution (1 mg) supplied for administration through durable medical equipment (DME). This code matters nationally because albuterol nebulization remains a common, guideline-supported therapy for bronchospasm across acute care and home settings; standardized coding supports accurate billing, coverage determinations, and monitoring of ambulatory and home-based respiratory therapy utilization.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for nebulized albuterol, typical sites of service and service line placement, and the payer landscape relevant to reimbursement and coverage policy. The publication outlines common modifiers associated with HCPCS medication billing and highlights where data are available and where input data are missing.
The audience will gain practical reference material: what J7613 denotes, how it fits into DME-delivered respiratory care, and which national payers commonly address claims for unit-dose albuterol solutions. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code J7613 represents albuterol inhalation solution, FDA-approved final product, non-compounded, administered through durable medical equipment (DME), unit dose, 1 mg. This service is the provision of a standardized, single-dose inhalation bronchodilator solution intended for use with nebulizer devices provided as DME.
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Service type: Medication administration via DME (inhalation solution)
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Typical site of service: Settings where DME nebulizer therapies are administered, such as the patient's home using durable medical equipment or outpatient infusion/respiratory therapy suites where nebulized inhalation therapy is provided.
Clinical & Coding Specifications
Clinical Context
A 7-year-old child with moderate persistent asthma presents to a pediatric pulmonology clinic for management of increased daytime cough and wheeze. The clinician prescribes nebulized short-acting bronchodilator therapy delivered via a durable medical equipment (DME) nebulizer at home. A single-use, FDA-approved non-compounded unit dose of albuterol inhalation solution, J7613 (1 mg), is supplied by the DME provider. The clinical workflow: the pulmonologist documents the diagnosis and need for a home nebulizer solution, writes the prescription specifying the unit-dose J7613 formulation to be administered through DME, the DME supplier verifies beneficiary coverage and ships unit-dose vials with patient instructions, and the patient/caregiver administers the inhalation solution per the prescribed frequency. Billing occurs to the patient’s medical or pharmacy benefit depending on payer rules, with J7613 reported for each unit-dose vial dispensed and appropriate modifiers appended when required for circumstances such as service location, waiver of liability, or partial administration.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / not otherwise specified |