Download MaineCare Covered Asthma Supplies List

Revised 02/13/04 - BG
MaineCare Covered Asthma Supplies
Drug Name
NDC
ACE AEROSOL CLOUD ENHANCE
ACE SPACER
AEROCHAMBER
AEROCHAMBER
AEROCHAMBER
AEROCHAMBER
AEROCHAMBER
AEROCHAMBER MASK
AEROCHAMBER MV
AEROCHAMBER PLUS/FLOW SIG
AEROCHAMBER PLUS/LARGE MA
AEROCHAMBER PLUS/MEDIUM M
AEROCHAMBER PLUS/SMALL MA
AEROCHAMBER/FLOWSIGNAL
AEROCHAMBER/MASK
AEROCHAMBER/MASK
AEROCHAMBER/MASK
AEROCHAMBER/MASK
AEROCHAMBER/MASK-LARGE
AEROCHAMBER/MASK-LARGE
AEROCHAMBER/MASK-SMALL
AEROCHAMBER/MASK-SMALL
AEROTRACH PLUS
AEROVENT II
ASTECH ADAPTER/USE WITH 1
BREATHERITE
BREATHERITE
BREATHERITE COLLAPSIBLE
BREATHERITE COLLAPSIBLE
BREATHERITE COLLAPSIBLE
BREATHERITE COLLAPSIBLE
BREATHERITE COLLAPSIBLE
BREATHERITE RIGID SPACER
BREATHERITE RIGID SPACER
BREATHERITE RIGID SPACER
BREATHERITE RIGID SPACER
BREATHERITE RIGID SPACER
BREATHERITE W/LARGE MASK
BREATHERITE W/LARGE MASK
BREATHERITE W/MEDIUM MASK
BREATHERITE W/MEDIUM MASK
BREATHERITE W/SMALL MASK
BREATHERITE W/SMALL MASK
BUBBLES THE FISH PEDI MAS
E-Z SPACER
E-Z SPACER MASK
49502020301
41353080100
00456315467
00456874513
52959100200
54569229400
54868451900
00456074513
04351098510
04351079710
04351080710
04351078710
04351088710
04351079510
04351078610
04351080510
04351088610
54569459800
00456074613
54569489300
00456074413
54569434400
04351052510
04351085750
49502020212
11391030100
11391030200
11391030201
11391030202
11391030203
11391030204
11391030205
11391030101
11391030102
11391030103
11391030104
11391030105
11391030110
11391030210
11391030120
11391030220
11391030130
11391030230
44229044044
59196000901
59196002001
1 of 4
Revised 02/13/04 - BG
MaineCare Covered Asthma Supplies
Drug Name
NDC
E-Z SPACER/MASK
E-Z-V
EASIVENT
EASIVENT
EASIVENT
EASIVENT/MASK-LARGE
EASIVENT/MASK-MEDIUM
EASIVENT/MASK-SMALL
ELLIPSE COMPACT SPACER
INHAL-AID
INHALER COMPANIONS
INSPIREASE
INSPIREASE
INSPIREASE DRUG DELIVERY
INSPIREASE DRUG DELIVERY
INSPIREASE DRUG DELIVERY
MICROCHAMBER/MASK MEDIUM
MICROCHAMBER/MASK SMALL
OPTICHAMBER ADVANTAGE
OPTICHAMBER ADVANTAGE
OPTICHAMBER ADVANTAGE/LAR
OPTICHAMBER ADVANTAGE/MED
OPTICHAMBER ADVANTAGE/SMA
OPTICHAMBER FACE MASK/LAR
OPTICHAMBER FACE MASK/MED
OPTICHAMBER FACE MASK/SMA
OPTIHALER
OPTIHALER
OPTIHALER
OPTIHALER
OPTIHALER MDI DRUG DELIVE
PANDA MASK LARGE
PANDA MASK LARGE
PANDA MASK MEDIUM
PANDA MASK MEDIUM
PANDA MASK SMALL
PANDA MASK SMALL
PARI BABY CONVERSION PACK
PARI BABY CONVERSION PACK
PARI EXPIRATORY FILTER VA
PARI LC MANUAL INTERRUPTE
PARI LC MASK SET WITH Y P
PARI LC NEB SET ADULT MAS
PARI LC NEB SET PEDIATRIC
PARI LC PLUS EXPIRATORY F
PARI LC PLUS VALVE SET
59196002901
00173500601
49502020701
49502020725
54569474300
49502020803
49502020802
49502020801
00173500001
00085460001
47360017203
00085460370
00085460570
00085460201
00085460202
54569276600
47360017206
47360017205
08373080010
08373080050
08373080310
08373080210
08373080110
08373081310
08373081210
08373081110
08373076000
08373076510
08373076550
50486008420
08373076500
08439640105
08439640115
08439640103
08439640113
08439640102
08439640112
44229044003
44229044004
50486008284
44229022002
44229044006
44229022049
44229022050
44229041066
44229022011
2 of 4
Revised 02/13/04 - BG
MaineCare Covered Asthma Supplies
Drug Name
NDC
PARI MASK SET ADULT PP
PARI MASK SET ADULT PVC
PARI MASK SET PEDIATRIC
PARI MASK SET PEDIATRIC
PARI TREK PORTABLE POWER
PEDIATRIC AEROSOL MASK
PEDIATRIC MOUTHPIECE/DISP
PEDIATRIC PANDA MASK
PEDIATRIC PANDA MASK
PFLEX
SPACE CHAMBER ADULT MASK
SPACE CHAMBER ADULT MASK
SPACE CHAMBER INFANT MASK
SPACE CHAMBER PEDIATRIC M
THRESHOLD IMT
ZOEY OPTICHAMBER
ADAPTER PED MOUTHPIECE MW
ADULT DISPOSABLE MOUTHPIE
ADULT DISPOSABLE MOUTHPIE
ASSESS DISPOSABLE MOUTHPI
ASSESS DISPOSABLE MOUTHPI
ASSESS DISPOSABLE MOUTHPI
ASSESS DISPOSABLE MOUTHPI
ASTECH DISPOSABLE MOUTHPI
ASTECH DISPOSABLE MOUTHPI
ASTECH DISPOSABLE MOUTHPI
DISPOSABLE MOUTHPIECE FUL
DISPOSABLE MOUTHPIECE LOW
DISPOSABLE MOUTHPIECE/LOW
DISPOSABLE MOUTHPIECE/UNI
DISPOSABLE SAFETY MOUTHPI
EXPIRATORY MOUTHPIECE
INSPIREASE MOUTHPIECE 144
INSPIREASE REPLACEMENT MO
KOKO PEAK PRO REPLACEMENT
MICROCHAMBER
MICROSPACER
MICROSPACER
MOUTHPIECE REUSABLE MW
PARI LC PLUS MOUTHPIECE
PARI MASK SET
PARI NEBULIZER MOUTHPIECE
PARI SOFT PLASTIC ADULT M
PARI SOFT PLASTIC PEDIATR
AIRZONE PEAK FLOW METER
AIRZONE PEAK FLOW METER
44229014009
44229014010
44229012008
44229014006
83490046002
33413056203
08439123020
08439640101
08439640111
08373055300
44229044026
44229044027
44229044022
44229044023
08373073000
08373080030
44229031007
08439060026
08439122002
00585118403
00585118404
08373071100
08373071200
49502020101
49502020248
49502020299
50486008411
50486008412
50486008322
50486008323
08373071400
08439060030
00085460401
00085460402
08439393535
47360017202
47360001721
47360017201
44229031002
44229022006
50486008225
44229012004
50486008271
50486008270
08439130025
08439905094
3 of 4
Revised 02/13/04 - BG
MaineCare Covered Asthma Supplies
Drug Name
NDC
AIRZONE PEAK FLOW METER
ASSESS FULL RANGE PEAK FL
ASSESS FULL RANGE PEAK FL
ASSESS LOW RANGE PEAK FLO
ASSESS LOW RANGE PEAK FLO
ASSESS PEAK FLOW METER
ASSESS PEAK FLOW METER
ASSESS PEAK FLOW METER FU
ASSESS PEAK FLOW METER FU
ASSESS PEAK FLOW METER LO
ASSESS PEAK FLOW METER LO
ASTECH PEAK FLOW METER
ASTECH PEAK FLOW METER
ASTHMA CHECK METER-ZONE S
ASTHMAMENTOR
INCHECK INSPIRATORY FLOW
MINI WRIGHT AFS LOW RANGE
MINI WRIGHT AFS PEAK FLOW
MINI WRIGHT PEAK FLOW MET
MINI WRIGHT PEAK FLOW MET
MINI WRIGHT STD PEAK FLOW
MINI WRIGHT STD PEAK FLOW
PEAK AIR PEAK FLOW METER
PEAK FLOW METER
PERSONAL BEST FULL RANGE
PERSONAL BEST FULL RANGE
PERSONAL BEST LOW RANGE
PERSONAL BEST LOW RANGE
PIKO 1
PIKO 1
PIKO 1
PIKO 1
POCKET PEAK FLOW METER
POCKET PEAK FLOW METER
POCKETPEAK PEAK FLOW METE
POCKETPEAK PEAK FLOW METE
POCKETPEAK PEAK FLOW METE
POCKETPEAK PEAK FLOW METE
TRUZONE PEAK FLOW METER
TRUZONE PEAK FLOW METER
ZOEY PERSONAL BEST FULL R
ZOEY PERSONAL BEST LOW RA
83490031024
08373071000
08373071800
08373071900
08373075000
00585118401
00585118402
08373071812
50486008410
08373071912
50486008415
41353070100
49502020001
08373074000
08373074200
08439109750
08439905093
08439104001
44229031001
44229031008
08439103001
08439905092
73796069940
50486008320
08373075500
54569488700
08373075600
54569488600
08439345010
08439345011
08439345012
08439345013
08439600101
08439600112
31253060207
50486008321
65845001800
65845001801
04351096510
44229031017
08373075530
08373075630
4 of 4