SADMERC LETTERS
Centers for Medicare and Medicaid Services
For information about Medicare and Medicaid reimbursement, please visit www.cms.gov
Reimbursement and Reference Information
| Part # | Description | NDC | UPC | HCPCS Code(s) | Case Qty |
|---|---|---|---|---|---|
| 018F63 | PARI PEP™ S | 83490-0180-12 | 7-44229-18012-8 | - | 12 |
| 022F51 | PARI LC® Star Resusable Nebulizer | 83490-0220-82 | 7-44229-22082-4 | A7005 | 12 |
| 022F62 | PARI LC PLUS® w/ Adult Aerosol Mask | 83490-0220-49 | 7-44229-22049-7 | A7005 | 12 |
| 022F63 | PARI LC PLUS® w/ Pediatric Aerosol Mask | 83490-0220-50 | 7-44229-22050-3 | A7005 | 12 |
| 022F81 | PARI LC PLUS® Reusable Nebulizer | 83490-0220-28 | 7-44229-22028-2 | A7005 | 12, 50 |
| 022F81-R | PARI LC PLUS®, Retail Sold only in case qty | 83490-0221-36 | 7-44229-22136-4 | A7005 | 12 |
| 022F90 | PARI BABY™ w/ Nebulizer Set, Sz 0 | 83490-0220-36 | 7-44229-22036-7 | A7005 | 12 |
| 022F91 | PARI BABY™ w/ Nebulizer Set, Sz 1 | 3490-0220-37 | 7-44229-22037-4 | A7005 | 12 |
| 022F92 | PARI BABY™ w/ Nebulizer Set, Sz 2 | 83490-0220-38 | 7-44229-22038-1 | A7005 | 12 |
| 023F35 | PARI LC® Sprint Reusable Nebulizer | 83490-0230-01 | 7-44229-23001-4 | A7005 | 50 |
| 023F35-R | PARI LC® Sprint, Retail Sold only in case qty | 83490-0230-11 | 7-44229-23011-3 | A7005 | 12 |
| 031F03 | Mini Wright Peak Flow Meter, Standard | 83490-0310-01 | 7-44229-31001-3 | A4627 | - |
| 031F05 | Mini Wright Peak Flow Meter, Pediatric | 83490-0310-08 | 7-44229-31008-2 | A4627 | - |
| 031F06 | AirZone Peak Flow Meter | 83490-0310-24 | 7-44229-31024-2 | A4627 | - |
| 041E4851P12 | Replacement Air Filters: PARI Trek® S and Vios®, only in case qty | 83490-0410-58 | 7-44229-41058-4 | A7013 | 12 |
| 041F05 | Filter Valve Set | 83490-0410-03 | 7-44229-41003-4 | - | 50 |
| 041F0522P30 | Expiratory Filter Pads, 30 pack Sold only in case qty | 83490-0410-09 | 7-44229-41009-6 | - | 30 |
| 041F3500 | Noseclip | 83490-0410-88 | 744229-41088-1 | - | - |
| 044B4612 | Pressure Monitor | 83490-0440-38 | 7-44229-44038-3 | E1399 | - |
| 044E0050 | Wing Tip® Tubing | 83490-0440-70 | 7-44229-44070-3 | E1399 | 100 |
| 044F2206 | DC/AC Converter 115V Adapter | 83490-0440-73 | 7-44229-44073-4 | - | 12 |
| 044F2400 | PARI BABY™, Sz 0 | 83490-0440-66 | 7-44229-44066-6 | A7015 | 12 |
| 044F2401 | PARI BABY™, Sz 1 | 83490-0440-03 | 7-44229- 44003-1 | A7015 | 12 |
| 044F2402 | PARI BABY™, Sz 2 | 83490-0440-04 | 7-44229-44004-8 | A7015 | 12 |
| 044F3301 | PARI BABY™, Sz 3 | 83490-0440-06 | 7-44229-44006-2 | A7015 | 12 |
| 044F5110 | Vortex® Toddler Ladybug Mask | 8349-0440-80 | 7-44229-44080-2 | A7015 | 12 |
| 044F5210 | Vortex® Child Frog Mask | 8349-0440-81 | 7-44229-44081-9 | A7015 | 12 |
| 044F7247 | Vortex® Adult Mask | 83490-0440-61 | 7-44229-44061-1 | A7015 | 50 |
| 044F7248 | Bubbles the Fish™ II Pedatric Aerosol Mask | 83490-0440-68 | 7-44229-44068-0 | A7015 | 50 |
| 044F7252 | Adult Aerosol Mask | 83490-0440-79 | 7-44229-44079-6 | A7015 | 144 |
| 046F0005 | 12V DC Adapter, PARI Trek® S | 83490-0460-04 | 7-44229-46004-6 | - | - |
| 047F0015 | Multi Voltage AC Adapter, PARI Trek® S | 83490-0470-08 | 7-44229-47008-3 | - | - |
| 047F0020 | PARI Trek® S Replacement Battery | 83490-0470-07 | 7-44229-47007-6 | - | - |
| 047F25 | PARI Trek® S Portable Power Pack | 83490-0470-04 | 7-44229-47004-5 | - | - |
| 047F3000 | PARI Trek® S Carry Case | 83490-0470-09 | 7-44229-47009-0 | - | - |
| 047F35-LCS | PARI Trek® S Combo Pack | 83490-0470-05 | 7-44229-47005-2 | E0570, A7005 | 6 |
| 047F45-LCS | PARI Trek® S | 83490-0470-06 | 7-44229-47006-9 | E0570, A7005 | 6 |
| 051F5000 | Vortex® Non-Electrostatic Holding Chamber | 83490-0510-01 | 7-44229-51001-7 | A4627 | 12 |
| 051F5110 | Vortex® w/ Toddler Ladybug Mask (age 1-2 years) | 83490-0510-22 | 7-44229-51022-2 | A4627 | 12 |
| 051F5210 | Vortex® with Child Frog Mask (age 3+ years) | 83490-0510-23 | 7-44229-51023-9 | A4627 | 12 |
| 051H5400P50 | Vortex® Hospital Package 50 Pack Sold only in case qty | 83490-0510-11 | 7-44229-51011-5 | A4627 | 50 |
| 310F35-LCS | Vios®, LC® Sprint | 83490-0310-58 | 7444229-31058-7 | E0570, A7005 | 6 |
| 310F35-LSD | Vios®, LC® Sprint, Deluxe | 83490-0310-59 | 7444229-31059-4 | E0570, A7005 | 6 |
| 310F35-P | Vios®, LC® Sprint, Pediatric | 83490-0310-62 | 7444229-31062-4 | E0570, A7005 | 6 |
| 310F81-LCD | Vios®, LC PLUS®, Deluxe | 83490-0310-64 | 7444229-31064-8 | E0570, A7005 | 6 |
| 310F83-LC+ | Vios®, LC PLUS® | 83490-0310-67 | 7444229-31067-9 | E0570, A7005 | 6 |
| 310F83-P | Vios®, LC PLUS®, Pediatric | 83490-0310-71 | 7444229-31071-6 | E0570, A7005 | 6 |
| 312F83-LC | Vios® PRO, LC PLUS® | 83490-0312-03 | 7-44229-31203-1 | - | - |
| 312F35-LCS | Vios® PRO, LC Sprint | 83490-0312-02 | 7-44229-31202-4 | - | - |
