Covered by Medicare, separately payable if the related aerosol compressor and individual accessories are medically necessary.

1. Administration set, disposable - two/month
2. Small volume nonfiltered pneumatic nebulizer, disposable - two/month
3. Aerosol mask, used with nebulizer - one/month
4. Filter, disposable - two/month

Utilization limits for supplies:

• Tracheostomy mask or collar - usual maximum replacement = one/month
• Administration set, small volume nonfiltered pneumatic nebulizer, disposable - usual maximum replacement = two/month
• Small volume nonfiltered, pneumatic nebulizer, disposable - usual maximum replacement = two/month
• Administration set, small volume nonfiltered pneumatic nebulizer, non-disposable - usual maximum replacement = one/six months
• Administration set, small volume filtered pneumatic nebulizer - usual maximum replacement = one/month
• Filter, disposable, used with aerosol compressor - usual maximum replacement = two/month
• Aerosol mask, used with DME nebulizer - usual maximum replacement = one/month