CurrentEmblemHealthPolicy N/A

NYRx and NYS Medicaid DMEPOS Nebulizers

Describes who (Pharmacy, NYRx, DMEPOS providers, MCOs) is responsible for nebulizers, nebulizer medications, and associated supplies under NYRx and NYS Medicaid, and where providers should bill or obtain codes. Affects NY Medicaid members, NYRx-enrolled pharmacies, DMEPOS providers, and MCOs.

Policy Summary

PayerEmblemHealth

PolicyNYRx and NYS Medicaid DMEPOS Nebulizers

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionUse the chart to determine whether an item is billed by pharmacy or DMEPOS and refer to the NY State Medicaid DMEPOS Procedure Codes and Coverage Guidelines for full HCPCS code guidance.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multipleexample HCPCS/supply codes cited

NYRxresponsible party for medications

Pharmacy & DMEPOSshared supplier responsibility

devices/rentalsMCO responsibility

1-833-967-7310support contact

Coverage and Billing Responsibility

Coverage and billing responsibility chart

Provider/source responsibility chart — who supplies and who is financially responsible:

ALL of the following

Available from: Pharmacy
Responsible party: NYRx
Codes: NYRx List of Reimbursable Drugs

ALL of the following

Available from: DMEPOS provider

Policy Summary

PayerEmblemHealth

PolicyNYRx and NYS Medicaid DMEPOS Nebulizers

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionUse the chart to determine whether an item is billed by pharmacy or DMEPOS and refer to the NY State Medicaid DMEPOS Procedure Codes and Coverage Guidelines for full HCPCS code guidance.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Example Codes and References

Example HCPCS/supply codes referencedHCPCS

E0570	Nebulizer (with compressor)
E0575	Ultrasonic large volume nebulizer
A7015	Aerosol mask, used with DME nebulizer
A7005	Administration kit, non-disposable (small volume)
A7003	Administration kit, disposable (small volume)
A7004	Small volume nonfiltered pneumatic nebulizer, disposable
A7007	Large volume nebulizer, disposable, unfilled
E0424	30-day rental: stationary compressed gaseous oxygen system (includes nebulizer)
S8100F	Holding chamber or spacer with mask (S8100F 21 / S8101F 21 listed)

Full code reference — NY State Medicaid DMEPOS Procedure Codes and Coverage Guidelines

ReferenceRefer to New York State Medicaid Program Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Procedure Codes and Coverage Guidelines for the full HCPCS and supply code list.

PurposeProvides the authoritative, complete list of HCPCS and supply codes referenced for DMEPOS nebulizer items and accessories.

Where to useUse this reference when determining correct billing codes for nebulizers, masks, administration kits, and related supplies.

NotesNot all nebulizer supplies are carried by pharmacies; providers may need to consult the DMEPOS code list and supplier look-up tool.

Billing Pathway and Provider Instructions

Billing Rule

Billing Pathway and Code Reference

Nebulizer compressors, accessories, and associated medications are available from different providers and covered by different parts of the Medicaid benefit. Use the chart in this policy to determine whether an item should be billed by a pharmacy (prescription drug benefit) or as DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies).

Refer to the New York State Medicaid Program Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Procedure Codes and Coverage Guidelines for the full list of HCPCS and supply codes.
To locate a NYRx-enrolled pharmacy or a NY DMEPOS provider, use the pharmacy or medical equipment supplier look‑up tool.
Not all pharmacies stock nebulizer supplies; members may need to obtain supplies from a DMEPOS provider.

Key Terms

Nebulizer — definition

DefinitionA nebulizer is a machine that creates a mist out of liquid medication for inhalation; it includes a compressor base, a medication holding chamber, and delivery tubing.

ComponentsKey parts include the air compressor base, medication holding chamber, and tubing for delivery to the patient.

UseMembers require both the nebulizer device and the prescribed nebulizer medication; additional masks or administration kits may be needed for ongoing use.

Billing contextNebulizer devices (e.g., compressor-based units) are typically available from DMEPOS providers and listed with HCPCS codes such as E0570 or E0575 for coverage responsibility determinations.

DMEPOS — definition

DefinitionDMEPOS stands for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies; these providers supply durable equipment and related supplies under NYS Medicaid.

Typical itemsIncludes compressor nebulizers, large-volume nebulizers, administration kits, masks, and other reusable or disposable nebulizer supplies referenced by HCPCS codes.

Provider roleDMEPOS providers supply nebulizer devices and certain supplies; responsibility for devices and rentals may fall to the MCO per coverage guidance.

Coding guidanceFor complete HCPCS and supply code listings for DMEPOS items, refer to the New York State Medicaid DMEPOS Procedure Codes and Coverage Guidelines.