<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 10.09.18.05" title_num="10" subtitle_num="09" chapter_num="18" heading="Limitations.">
  <paragraph num="A.">
    <text>The Program does not cover:</text>
    <paragraph num="(1)">
      <text>Any service or items not identified in Regulation .04 of this chapter;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Demurrage;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Charges for delivery;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Equipment prescribed primarily to provide comfort or convenience, including, but not limited to, air conditioners and room humidifiers;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Items which are investigational or experimental in nature;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Oxygen and related equipment not for pulmonary use;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Pre-set oxygen for emergency use;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Trach string or tape.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The Program places the following limitations upon covered services:</text>
    <paragraph num="(1)">
      <text>Reimbursement for aerosol equipment will only be provided if a hand held nebulizer has been tried and is not successful, as indicated in the clinical summary;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Reimbursement for IPPB machine will only be authorized if the aerosol compressor with the nebulizer kit has been tried and is not successful, as indicated in the clinical summary;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Reimbursement may not be made for:</text>
      <paragraph num="(a)">
        <text>Repairs or replacement parts for rented items;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Oxygen prescribed on an as-needed basis (PRN);</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Oxygen prescribed for stand-by purposes;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Piped-in oxygen;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Oxygen and related respiratory equipment and services provided in a facility or by a group when reimbursement is covered by another segment of the Program; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Payment for portable oxygen will be made only when:</text>
      <paragraph num="(a)">
        <text>It is required in the pursuit of medical treatment; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The medical necessity is indicated for this type of system.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>