Limited Use Note(s)

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IPRATROPIUM BROMIDE125mcg/mL Inh Sol-2mL UDV Pk
Reason For Use CodeClinical Criteria
For the vast majority of patients, a metered dose inhaler is the preferred therapy. Nebulizer therapy will be reimbursed for patients who are unable to use a metered dose inhaler, including an inhaler with a spacer attachment, or a turbuhaler.
265Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have a tracheostomy;
LU Authorization Period: Indefinite
266Individuals must have a known hypersensitivity to the preservative in the bulk solution, and be patients with cystic fibrosis in whom nebulizer therapy is indicated;.
LU Authorization Period: Indefinite
267Individuals must have a known hypersensitivity to the preservative in the bulk solution, and have severe mental or physical disabilities;
LU Authorization Period: Indefinite
268Patients who have previously used nebulizer therapy within the last 12 month period.
LU Authorization Period: Indefinite