Coverage Criteria for Healthcare Providers

Criteria for Coverage

Need a prescription and chart notes.


  • Diagnosis: Must include a diagnosis (e.g. Asthma – J45.909 or Chronic Obstructive Pulmonary Disease – J44.9).
  • Length of Need: Indicate the duration for which the nebulizer is required.
  • >Quantity: Specify the quantity of nebulizer prescribed.
  • Date: Include the date of the prescription.
  • Signature: Must be signed by the prescribing healthcare provider.

Note: A template from Kohll’s Rx may be faxed over to ensure all necessary information is provided in the prescription.


  • Must be less than a year old.
  • Must mention that the patient is currently taking medication that requires nebulization and how they will benefit from the nebulizer.
These criteria help ensure that the patient meets the necessary medical requirements for the prescription and use of a nebulizer, and they also provide a basis for insurance coverage. It’s important for healthcare providers to adhere to these criteria to facilitate the approval process for nebulizer prescriptions.