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 - -

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