J45.42: Moderate persistent asthma with status asthmaticus
J45.42, moderate persistent asthma with status asthmaticus, is listed as a covered diagnosis in 10 Medicare billing and coding articles that apply to 67 HCPCS Level II codes, including J2357 (Injection, omalizumab, 5 mg), Q5154 (Injection, omalizumab-igec (omlyclo), biosimilar, 5 mg), U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19)…). 20 of these codes have a 2026 DMEPOS fee schedule amount; K0730 pays $245.69 (RR) depending on the state. The articles come from 5 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.
HCPCS Level II codes with J45.42 as a covered diagnosis
| Code | Description | Medicare coverage | DMEPOS fee 2026 (state range) | Articles listing it |
|---|---|---|---|---|
| J2357 | Injection, omalizumab, 5 mg | Carrier judgment | — | 1 |
| Q5154 | Injection, omalizumab-igec (omlyclo), biosimilar, 5 mg | Carrier judgment | — | 1 |
| U0002 | 2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc | Carrier judgment | — | 4 |
| U0001 | Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr diagnostic panel | Carrier judgment | — | 4 |
| G0238 | Therapeutic procedures to improve respiratory function, other than described by g0237, one on one, face to face, per 15 minutes (includes monitoring) | Carrier judgment | — | 2 |
| G0237 | Therapeutic procedures to increase strength or endurance of respiratory muscles, face to face, one on one, each 15 minutes (includes monitoring) | Carrier judgment | — | 2 |
| G0239 | Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring) | Carrier judgment | — | 2 |
| K0730 | Controlled dose inhalation drug delivery system | Carrier judgment | $245.69 (RR) | 1 |
| E1372 | Immersion external heater for nebulizer | Special coverage instructions apply | $136.61–$208.94 (NU) | 1 |
| A7017 | Nebulizer, durable, glass or autoclavable plastic, bottle type, not used with oxygen | Special coverage instructions apply | $130.82–$194.58 (NU) | 1 |
| E0580 | Nebulizer, durable, glass or autoclavable plastic, bottle type, for use with regulator or flowmeter | Special coverage instructions apply | $164.65–$182.27 (NU) | 1 |
| E0575 | Nebulizer, ultrasonic, large volume | Special coverage instructions apply | $124.51–$159.48 (RR) | 1 |
| E0565 | Compressor, air power source for equipment which is not self-contained or cylinder driven | Carrier judgment | $42.74–$82.96 (RR) | 1 |
| E0574 | Ultrasonic/electronic aerosol generator with small volume nebulizer | Carrier judgment | $48.76–$67.63 (RR) | 1 |
| E0585 | Nebulizer, with compressor and heater | Special coverage instructions apply | $32.06–$60.76 (RR) | 1 |
| E0572 | Aerosol compressor, adjustable pressure, light duty for intermittent use | Carrier judgment | $29.16–$51.74 (RR) | 1 |
| A7005 | Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable | Carrier judgment | $11.77–$29.20 (NU) | 1 |
| A7008 | Large volume nebulizer, disposable, prefilled, used with aerosol compressor | Carrier judgment | $12.46–$18.09 (NU) | 1 |
| A7016 | Dome and mouthpiece, used with small volume ultrasonic nebulizer | Carrier judgment | $9.31–$17.75 (NU) | 1 |
| E0570 | Nebulizer, with compressor | Special coverage instructions apply | $6.09–$15.43 (RR) | 1 |
| A7006 | Administration set, with small volume filtered pneumatic nebulizer | Carrier judgment | $8.19–$14.94 (NU) | 1 |
| A7007 | Large volume nebulizer, disposable, unfilled, used with aerosol compressor | Carrier judgment | $3.47–$5.87 (NU) | 1 |
| A7012 | Water collection device, used with large volume nebulizer | Carrier judgment | $3.25–$5.03 (NU) | 1 |
| A4217 | Sterile water/saline, 500 ml | Special coverage instructions apply | $2.18–$4.93 | 1 |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | Carrier judgment | $1.86–$3.26 (NU) | 1 |
42 more codes are listed. See every code with payment by region in Caduvo.
Medicare policy articles listing J45.42
- A52448: Billing and Coding: Omalizumab and biosimilar, OMLYCLO® (omalizumab-igec) (Wellpoint Federal (MAC - Part A, MAC - Part B); 2 Level II codes)
- A52466: Nebulizers - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC); 53 Level II codes). LCD with the same title: L33370
- A56717: Billing and Coding: Respiratory Therapy (Respiratory Care) (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34430
- A58710: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (Palmetto GBA (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58720: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58761: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (WPS Insurance Corporation (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A58747: Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing (CGS Administrators, LLC (MAC - Part A, MAC - Part B); 2 Level II codes). LCD with the same title: L38988, L39001, L39038, L39044
- A57224: Billing and Coding: Respiratory Care (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B); 3 Level II codes). LCD with the same title: L34149
- A53057: Billing and Coding: Home Health Occupational Therapy (Palmetto GBA (HHH MAC); 5 Level II codes). LCD with the same title: L34560
- A53064: Billing and Coding: Outpatient Occupational Therapy (Palmetto GBA (MAC - Part A); 3 Level II codes). LCD with the same title: L34427
A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.
Other J45 diagnoses (Asthma)
- J45.40 — Moderate persistent asthma, uncomplicated
- J45.41 — Moderate persistent asthma with (acute) exacerbation
- J45.20 — Mild intermittent asthma, uncomplicated
- J45.21 — Mild intermittent asthma with (acute) exacerbation
- J45.22 — Mild intermittent asthma with status asthmaticus
- J45.30 — Mild persistent asthma, uncomplicated
- J45.31 — Mild persistent asthma with (acute) exacerbation
- J45.32 — Mild persistent asthma with status asthmaticus
- J45.50 — Severe persistent asthma, uncomplicated
- J45.51 — Severe persistent asthma with (acute) exacerbation
- J45.52 — Severe persistent asthma with status asthmaticus
- J45.901 — Unspecified asthma with (acute) exacerbation
- J45.902 — Unspecified asthma with status asthmaticus
- J45.909 — Unspecified asthma, uncomplicated
- J45.990 — Exercise induced bronchospasm
- J45.991 — Cough variant asthma
- J45.998 — Other asthma
Frequently asked questions
Does Medicare cover J45.42 (Moderate persistent asthma with status asthmaticus)?
Medicare covers items and services, not diagnoses. 10 Medicare billing and coding articles list J45.42 as a covered diagnosis for 67 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.
Which HCPCS codes can be billed with ICD-10 J45.42?
The Level II codes from the policies most specific to this diagnosis are J2357 (Injection, omalizumab, 5 mg, 1 article); Q5154 (Injection, omalizumab-igec (omlyclo), biosimilar, 5 mg, 1 article); U0002 (2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19)…, 4 articles); U0001 (Cdc 2019 novel coronavirus (2019-ncov) real-time rt-pcr…, 4 articles); G0238 (Therapeutic procedures to improve respiratory function…, 2 articles). Code choice depends on the item supplied; check each code's descriptor.
What does Medicare pay for equipment billed with J45.42?
Under the 2026 DMEPOS fee schedule (non-rural state fees): K0730 $245.69 (RR); E1372 $136.61 to $208.94 (NU); A7017 $130.82 to $194.58 (NU); E0580 $164.65 to $182.27 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.
Which Medicare policy articles list J45.42?
A52448 (Billing and Coding: Omalizumab and biosimilar, OMLYCLO® (omalizumab-igec)); A52466 (Nebulizers - Policy Article); A56717 (Billing and Coding: Respiratory Therapy (Respiratory Care)), and 7 more articles.
What is ICD-10-CM code J45.42?
J45.42 is the ICD-10-CM code for moderate persistent asthma with status asthmaticus, in category J45 (Asthma), chapter 10: Diseases of the respiratory system.
Next steps
- Run a reimbursement report for a device billed under J2357
- Watch J2357 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J2357
Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.
Chapter 10: Diseases of the respiratory system · All diagnoses · HCPCS lookup