CORRECT CODING – TOBI® PODHALER™
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 TOBI® 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 website: https://www.dmepdac.com/.
Published by Noridian as the PDAC, October 2015. Republished by Palmetto GBA as the PDAC, February 2019. Please note that links in this document were accurate at the time of original publication and may change over time and are no longer active.