Limited Use Note(s)

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IPRATROPIUM BROMIDE/SALBUTAMOL500mcg/2.5mg/2.5mL Inh Sol-2.5mL Amp 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.
256Patients who have a tracheostomy;
LU Authorization Period: Indefinite
257Patients with cystic fibrosis in whom nebulizer therapy is indicated;
LU Authorization Period: Indefinite
258Patients with severe mental or physical disabilities;
LU Authorization Period: Indefinite
259Patients who have previously used nebulizer therapy within the last 12 month period.
LU Authorization Period: Indefinite