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7% Saline Prescription and Medicare Part B payment quandry
My husband is 81, diagnosed with MAC, and has been on the 3-drug regimen for 2.5 weeks. He uses a nebulizer 2XDay with 7% saline.
Problem: Humana won't cover the saline prescription because they say it is covered under Medicare Part B. But, when filling the saline prescription the pharmacist can't get Medicare Part B to work. Our secondary (not supplemental) health insurance Blue Cross/Blue Shield says (thinks?) it needs to be coded as a durable medical, which neither CVS nor Medicap will use. (It seems to me that while the nebulizer is a durable medical; the saline is more a prescription.) In the meantime, we are paying out-of-pocket for a saline prescription the pulmonologist and all others say should be covered under Medicare Part B. Anyone else had this experience? How was it resolved? Many thanks!
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CVS told me that in order for Medicare Part B to reimburse for saline solution, your pulmonologist must prescribe another medication along with the saline solution.
I don’t understand the reasoning behind this, and have not talked to the pulmonologist about it yet.
Dear Elle,
I have finally given up on getting the saline covered by Medicare. Have you tried using a GoodRx coupon? I just checked on their current prices. Both Walgreens and Walmart have the cheapest prices, but good only one time. Otherwise, CVS' prices are as follows: 60 vials (1 box) $11.97, 120 vials, $20.15, 180 vials, $25.55, and 240 vials, $30.95. If you can find Sue's (our mentor) entries, she explains how she has gotten Medicare to cover saline. Good luck! Donna T
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2 ReactionsHas anyone run into trouble in the new year with their Sodium Chloride 7% Solution being newly denied(!!?!) under Medicare Part B durable equipment coverage? I finally had my CVS on automatic with this and it was running smoothly until today. Hope its just a glitch.
I have never been able to get mine covered. The pharmacy attached to the BE Center of Excellence I use told me that Medicare does not cover this unless prescribed for a medication that is to be mixed with it. Normally one does not mix albuterol and 7% saline. I use GoodRX and get a 30 day supply for about $10.00.
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2 ReactionsThe issues of Medicare coverage of levalbuterol and saline drive me nuts. Medicare is very unhelpful. On saline, I gave up and ordered 7% saline form amazon, https://www.amazon.com/dp/B0BNNV3JW6?ref=ppx_yo2ov_dt_b_fed_asin_title. I see no reason why it shouldn't be just as good.
All my nebulizers go through the prescription plan and I have Medicare advantage Aetna PPO
Here is what a search on Microsoft Copilot AI had to say: Yes, Medicare Part B generally covers inhalation drugs like 7% saline solution if they are prescribed by a physician and used with a nebulizer, which is considered durable medical equipment (DME). However, coverage often depends on the specific diagnosis code provided by the physician and whether the pharmacy processes the prescription correctly under Medicare Part B.
If you're facing challenges with coverage, it might help to:
1. Confirm with your doctor that the correct diagnosis code is being used.
2. Ensure the pharmacy is billing it under Medicare Part B, not Part D.
3. Consider reaching out to Medicare or your secondary insurance for clarification.
The correct diagnosis code for ordering a 7% saline solution for use with a nebulizer depends on the underlying medical condition being treated. Common conditions that might require this treatment include **cystic fibrosis**, **bronchiectasis**, or **chronic obstructive pulmonary disease (COPD)**. Each condition has its own ICD-10 diagnosis code, such as:
- **E84.0** for cystic fibrosis with pulmonary manifestations.
- **J47.9** for bronchiectasis, unspecified.
- **J44.9** for COPD, unspecified.
It's essential to consult with the prescribing physician to ensure the diagnosis code aligns with the patient's specific medical condition and treatment plan. If you're dealing with insurance coverage, the physician or pharmacist might also need to verify the code with the insurer.
Hope this is helpful.
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5 ReactionsNot covered ever for me on Medicare and Medicaid.
I use 7% saline when I nebulizer and hate all the plastic bottles it comes in, so I bought a bottle of pharmaceutical grade sodium chloride and distilled water and make my own solution and store in glass bottle. 100 ml water with 7 1 gram tablets makes 7%. I like having control over this little part of my health.
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2 ReactionsI always appreciate the less-plastics approach and applaud your determination to do your part. I make my own yougurt and store it in glass jars for the same reason. My daughter reuses the gallon jugs to start all her seeds in winter.
A few questions I can think of -
Do you sterilize the bottle and the distilled water? Depending on bottling/handling methods, Dr Joe Falkinham and his students have found that distilled water is not always sterile.
Where do you store the homemade solution, and for how long? My daughters (RN's) taught me - open sterile containers at room temperature are to be discarded after 24 hours, refrigerated after 72 hours. Knowing that bacteria don't reproduce well in 7% saline, I personally would fell safe storing in the refrigerator for up to 7 days.
And a caution - be sure when pouring the sterile water into the nebulizer not to touch the lip of the bottle with fingers.
If I need to return to daily 7% saline nebs, I will definitely consider this!