9.0 Self-care equipment and supplies benefits list
Effective date: September 27, 2024
The following Medical Supplies and Equipment (MS&E) list contains self-care items and services eligible under the Non-Insured Health Benefits (NIHB) program for eligible First Nations and Inuit. Further you'll find information on coverage policies, item codes, requirements for prior approval and applicable recommended replacement guidelines.
Table of contents
9.1 General information
9.1.1 Benefit policies
General information common to all medical supplies and equipment (MS&E) can be found in the general policies.
9.1.2 Prescriber and provider requirements
Prescriptions or recommendations for coverage must be initiated by the health professionals identified as prescribers or recommenders of the specific item as listed in the tables. Items that are prescribed by prescribers/recommenders not recognized by NIHB will lead to denials or reversal of claims.
The following is a list of NIHB-recognized prescriber/recommender abbreviations found in this segment of the benefits list. Please refer to the prescriber section of the item tables below to identify the eligible prescriber/recommender of a specific item:
- LPN/RPN – Licensed Practical Nurse/Registered Practical Nurse when within their scope of practice in their province/territory
- MD — Physician
- NP — Nurse Practitioner
- OT — Occupational Therapist
- PSY — Psychologist
- PT — Physiotherapist
- RD — Registered Dietitian
- RM — Registered Midwife
- RN — Registered Nurse
- RRT — Registered Respiratory Therapist
- SLP — Speech-Language Pathologist
The following is a list of NIHB-recognized provider abbreviations found in this segment of the benefits list. Please refer to the provider section of the item tables below to identify the eligible provider of a specific item:
- GEN — Enrolled general MS&E or pharmacy provider
9.1.3 Prior approval requirements
General prior approval requirements can be found in the general policies.
To initiate the prior approval process, the Self-care Prior Approval Form, found on the Express Scripts Canada NIHB provider and client website, must be completed in full and submitted to your NIHB regional office along with the following supporting documentation:
- the prescription or recommendation or referral form signed by an NIHB-recognized prescriber for the requested benefit
- detailed assessment as required
- relevant information the provider, physician, nurse practitioner, occupational therapist, psychologist or physiotherapist may have to support the request
- an explanation of benefits from any third-party coverage available to the client (for example, provincial plan, workers' compensation board, private insurance, education plan, etc.)
9.1.4 Exclusions
In addition to the general exclusion policy listed in the general policies, the following items are excluded from the self-care benefit and are not considered for coverage or appeal under the NIHB program:
- environmental protection devices and supplies (for example, air cleaners, filters, UV protection garments and lotions, etc.)
- permanently fixed equipment
- equipment with a rated capacity that would be unable to bear the client's weight
- lift chairs
- child's regular feeding bottle and teat
9.1.5 Warranties
Providers must honour the manufacturer's warranty.
9.1.6 Repairs
Repairs that are not covered under the warranty are eligible for coverage when supported by proper documentation.
The following rules apply:
- prior approval is required for repairs
- request must include detailed cost breakdown of parts, labour time and rates
- repairs must have a minimum warranty of 90 days
A description of all repairs with dates, detailed cost breakdown of parts, labour time and rates must be kept on file for each client.
Note: The NIHB program will not cover the labour cost for repairs that are covered under the warranty.
9.1.7 Replacement requirements
Recommended replacement guidelines indicate the quantity and frequency at which a benefit item will be eligible for coverage. Recommended replacement guidelines are based on a client's customary medical needs and the typical device's lifespan.
Replacement is subject to the same process as the original purchase.
All replacement requests require a new prescription.
For more general information please see section 1.12 Recommended replacement guidelines.
9.1.7.1 Early replacement requirements
Coverage requests for any early replacement require prior approval, a new prescription as well as documentation supporting the need for early replacement. The client must meet program and equipment specific eligibility criteria.
Early replacement of items may be considered when one of the following has occurred:
- there is a substantial change in a client's medical condition (for example, substantial change in weight, etc.) and the item no longer meets the client's needs
- the item is no longer functioning properly, has deteriorated during typical use and is no longer under warranty (where the cost of repair exceeds the cost of a new item)
The program will not cover the replacement of lost items, stolen items, or items that are damaged due to misuse or negligence.
9.1.8 Services included in the NIHB price
The following services must be included in the NIHB price to be considered for coverage:
- product and parts ordering and delivery from manufacturer to provider (including freight charges, exchange rate)
- dispensing of the benefit, which includes any required adjustments or fittings
9.1.9 Terminology
Item code
The item code is an 8-digit code that identifies the benefit being requested and is submitted to Express Scripts Canada for billing purposes.
Prior approval
A program coverage confirmation is issued by an NIHB regional office to a provider to ensure that the client is eligible for specific medical supplies and equipment benefits. The approval is issued primarily for items identified as requiring prior approval before being billed to the program. All claims, including claims accompanied by prior approvals, are subject to claim verification.
Recommended replacement guidelines
The recommended replacement guidelines set a maximum number of each item a client may receive over a given period (frequency). Coverage of additional items may be considered on a case-by-case basis. For requests exceeding the recommended replacement guidelines, prior approval is required.
NIHB price
NIHB price information is listed in the MS&E price files, located on the Express Scripts Canada NIHB provider and client website.
When an NIHB price is established for an item, it must not be claimed by default. To be eligible for payment, providers must adhere to the NIHB program's terms and conditions set out in their MS&E provider billing agreement and submit eligible claim amounts in accordance to the MS&E Claims Submission Kit and reimbursement policies.
9.2 Bathing and toileting aids
9.2.1 Bathing
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400295 | Bath chair | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years |
|
99400474 | Bath chair lift, battery powered | MD, NP, OT, PT | GEN | Yes | 1 every 5 years | |
99400935 | Bath chair lift, bariatric battery powered, purchase | MD, NP, OT, PT | GEN | Yes | 1 every 5 years | |
99400937 | Bath chair lift, battery | GEN | Yes | 1 per year | ||
99400936 | Bath chair lift, battery powered, rental | MD, NP, OT, PT | GEN | Yes | Rented for 1 month at a time | |
99400303 | Commode shower chair | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | Yes | 1 every 5 years | |
99401430 | Long-handled sponge | MD, NP, OT, PT, RN, LPN/RPNTable note 1Table note 2 | GEN | No | 1 per year | |
99400649 | Tub transfer rail (non-permanent) | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 3 years |
|
99400301 | Mat non-slip tub | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 2 years | |
99400304 | Tub transfer bench | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years |
|
99400305 | Tub transfer board | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years |
|
|
9.2.2 Toileting
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400294 | Bedpan | MD, NP, OT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 3 years | |
99400296 | Commode, standard, purchase | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years |
|
99400890 | Commode, wheeled, purchase | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400298 | Raised toilet seat, standard | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 3 years | |
99400299 | Raised toilet seat, standard with arm | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 3 years |
|
99400302 | Safety frame for toilet | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years |
|
99400306 | Urinal | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 3 years | |
99400297 | Commode, rental | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | Yes | Rented for 1 month at a time | |
99400878 | Toilet tissue aid | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years |
|
|
9.3 Cushion and protective aid
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400308 | Elbow protector, 1 pair | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 year | |
99400310 | Heel protector, 1 pair | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 per year | |
99400315 | Positioning wedge | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 3 years | A triangular foam wedge (generally with a 7, 10 or 12-inch height), covered in fabric, to be used on the bed to:
Must be large enough to support the client's entire upper body. OR A foam rectangle with one sloped end, covered in fabric, to be used on the bed to:
Must be large enough to support the client's legs. Standard residential bed pillows, cervical pillows and other shaped pillows are not eligible for coverage. |
99400316 | Quad knee separator | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 3 years | |
99400311 | Ring cushion | MD, NP, OT, PT, RM, RN, LPN/RPNTable note 1 | GEN | No | 1 every 3 years | |
|
9.4 Dressing aid
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400277 | Button hook | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400278 | Dressing stick | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99401439 | Hip kit | MD, NP, OT, PT, RN, LPN/RPNTable note 1Table note 2 | GEN | No | 1 every 5 years |
|
99400279 | Long handle shoe horn | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400280 | Reacher | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400281 | Sock/stocking aid | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
|
9.5 Feeding
9.5.1 Breastfeeding aids
The infant's date of birth must be indicated on the prescription/written recommendation.
Electric breast pump purchase or rental is considered for coverage only once the child is born and when a parent or infant presents medico-physical complications hindering the normal physiological process of chestfeeding. Prior authorization and medical documentation are required to support the request.
Information to provide includes:
- the medical justification supporting the need for the electric breast pump
- the date of birth
- the infant's weight
- the length of time the electric breast pump is needed
NIHB has created an Electric Breast Pump Recommendation Form, found on the Express Scripts Canada NIHB provider and client website, that can be printed and taken to the prescriber for ease of application.
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400317 | Breast pump, manual | MD, NP, RM, RN, LPN/RPN | GEN | No | one per birth event | |
99400658 | Breast pump, electric, rental | MD, NP, RM, RN | GEN | Yes |
|
|
99401153 | Breast pump, electric, purchase | MD, NP, RM, RN | GEN | Yes | 1 every 3 years | |
99400932 | Nipple shield | MD, NP, RM, RN, LPN/RPN | GEN | No | 6 shields every 3 months | Maximum coverage of 6 months |
9.5.2 Feeding aids
9.5.2.1 Specialized feeding bottles and teats
The child (0-18 years old) presents with complex feeding challenges where a regular feeding bottle and teat do not meet their needs.
Information required:
- completed and signed prior approval form
- device make, model, cost, and quantity of item requested
- prescription
- completed clinical feeding and swallowing assessment*, which includes:
- diagnosis
- please note that general information such as feeding difficulty is not sufficient information to support review
- physical concerns (for example, cleft lip, cleft palate, high-arched palate, syndromic sequences, etc.)
- oral motor skills (for example, poor lip seal, reduced tongue movement, reduced gag reflex, etc.)
- feeding or swallowing concerns (for example, choking, coughing, reduced sucking, etc.)
- current diet, including safe and unsafe consistencies
- recommendation for specialized feeding bottles and teats
- other relevant information to support review
- diagnosis
- replacement teat will be considered when the client meets the criteria for the specialized feeding kit and the replacement teat are required for one of the following reasons:
- damaged teat (for example, cracked, leaking, torn, etc.)
- different teat size is required (for example, size included in the kit is not appropriate for the child's developmental age and/or functional feeding skills, or the child has outgrown the teat size)
*A Specialized Feeding Bottles and Teats Assessment Form is available on the Express Scripts Canada NIHB provider and client website. When completed and signed by an NIHB-recognized prescriber, this form can also be used as the prescription/recommendation for specialized feeding bottles and teats. Please note: if another feeding and swallowing assessment report is submitted, the clinician must include the required assessment information.
Specialized feeding kits and replacement teat purchase will be considered for coverage only once the child is born.
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99401279 | Adaptive Cup | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 per year | |
99400287 | Built-up handle or universal cuff | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400288 | Food guard/bumper | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400289 | Non-slip placemat | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99401133 | Overbed table, purchase | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | Yes | ||
99401145 | Overbed table, rental | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | Yes | Rented for 1 month at a time | |
99400290 | Specialized utensil fork or spork | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400292 | Specialized utensil, spoon | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400291 | Specialized utensil, knife | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99401367 | Kit, Specialized feeding bottle and teat | MD, NP, RM, SLP, RN, OT | GEN | Yes | 8 bottles and 8 teats every 6 month |
|
99401368 | Teat, Replacement for specialized feeding kit | MD, NP, RM, SLP, RN, OT | GEN | Yes | 4 teats every 3 months |
|
|
9.5.3 Enteral feeding
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400476 | Adhesive remover, 50 wipes per box or 50ml per bottle | MD, NP, RN, RD | GEN | No | 6 boxes per year | For the long-term use of adhesives (for example, ostomy supplies, dressings, tape) |
99400286 | Enteral feeding, nasogastric tube | MD, NP, RN, RD | GEN | No | 24 per year | |
99400655 | Enteral feeding, supplies, gastrostomy catheter/tube | MD, NP, RN, RD | GEN | No | 12 per year | Also included: jejunal tube or a MIC-KEY jejunal tube |
99400656 | Enteral feeding, supplies, extension set | MD, NP, RN, RD | GEN | No | 12 per year | Device that connects to the main feeding system. Could Include extension sets such as a bolus or a Y extension set, for feeding bag system Higher frequencies will be considered on a case-by-case basis when medical justification is provided |
99400657 | Enteral feeding, supplies, adaptor plug | MD, NP, RN, RD | GEN | No | 12 per year | Adapter which provides a connection between feeding sets and tubes, or extension sets |
99400767 | Enteral feeding, button (tube) | MD, NP, RN, RD | GEN | Yes | 3 per year | Low profile G-tube (button) which lays on top of the abdominal wall, kept in place by a water filled balloon and is used for providing nutrition and medication |
99401124 | Backpack for feeding pump | MD, NP, RN, RD, OT | GEN | Yes | 1 per year | |
99400285 | Feeding pump, bag | MD, NP, RN, RD | GEN | No | 1 per day | Includes feeding bag with tubing (spike set). It can include a dual bag set such as a feed and flush bag combination Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99400284 | Feeding pump pole (iv pole) | MD, NP, RN, RD, OT, LPN/RPN | GEN | Yes | 1 per lifetime | |
99400283 | Feeding pump, purchase | MD, NP, RN, RD | GEN | Yes | 1 every 5 years | Medical documentation that establishes the client's inability to receive feeding through gravity |
99400282 | Feeding pump, rental | MD, NP, RN, RD | GEN | Yes | ||
99400530 | Feeding syringe, 3cc, disposable | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 1 per day | Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99400535 | Feeding syringe, 5cc, disposable | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 1 per day | Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99400539 | Feeding syringe,10 cc, disposable | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 1 per day | Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99400548 | Feeding syringe, 20cc, disposable | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 1 per day | Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99401246 | Feeding syringe, other, disposable | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 1 per day | Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99400653 | Gravity feeding bag | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 1 per day | Gravity feeding bag without tubing Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99400651 | Gravity feeding, delivery set with bag | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 1 per day | Combination of feeding bag with tubing Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99400652 | Gravity feeding, delivery set without bag | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 1 per day | Tubing from a gravity feeding set, without the bag Higher frequencies will be considered on a case-by-case basis for premature or immunocompromised children and for transplant patients |
99400654 | Gravity feeding, rigid container | MD, NP, RN, RD, (LPN/RPN - renewals only) | GEN | No | 24 per year | |
99400411 | Protective skin wipes/spray | MD, NP, RN, RD | GEN | No | 4 per year |
9.6 Gender identity
Providers must keep the following information in the client's file:
- prescriptions or recommendations for gender identity items require an indication of a diagnosis of gender dysphoria
- prescriptions or recommendations are required for the initial benefit request only
9.6.1 Upper body
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400921 | Bra inserts, pair | MD, NP, PSY | GEN | No | 1 every 2 years | |
99400922 | Brassiere for bra insert | MD, NP, PSY | GEN | No | 3 per year | |
99400920 | Compression - chest binder | MD, NP, PSY | GEN | No | 2 per year |
9.6.2 Lower body
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400923 | Compression - gaff or shorts | MD, NP, PSY | GEN | No | 2 per year | |
99400927 | Female urination aid (stand-to-pee device) | MD, NP, PSY | GEN | No | 1 per year | |
99400924 | Packer (phallus) | MD, NP, PSY | GEN | No | 1 per year | |
99400926 | Packer securement (strap/harness/brief) | MD, NP, PSY | GEN | No | 1 per year | |
99400925 | Packer with stand-to-pee | MD, NP, PSY | GEN | No | 1 per year | |
99400928 | Vaginal dilator, kit (4) | MD, NP, PSY | GEN | No | 1 every 5 years | |
99400929 | Vaginal dilator, single | MD, NP, PSY | GEN | No | 1 every 5 years |
9.7 Lifting and transfer
9.7.1 Bed assist rail
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400322 | Bed assist rail, purchase | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 10 years |
|
99400323 | Bed assist rail, rental | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | Yes | ||
|
9.7.2 Lift
The program only covers portable tracking systems. Ceiling lift where permanent tracking is already installed or covered by another program may be eligible for coverage.
Eligibility criteria:
- the client has a chronic, long-term disability resulting in an inability to safely transfer from one position to another, which requires assistive technology to lift and transfer the client between their bed and their wheelchair and/or the bathroom. (note: NIHB will only approve lifts for transfers between these surfaces)
- the client's weight is within the weight capacity of the device
- the client has no other lift in place that will meet their needs
- the client has been assessed in their home environment by an occupational therapist or physiotherapist
- if the client is funded for a floor lift and their medical condition changes significantly, a request for a ceiling lift may be considered
9.7.2.1 Information required
Prior approval is required. Assessment from an occupational therapist or physiotherapist must include:
- the need for the item
- the client's anthropometric measurements including height and weight
- the client's medical, physical status and functional level (for example, mobility)
- other relevant information
- justification is required for specialized sling requests
- device manufacturer, model, and weight capacity
- completed manufacturer's order sheet
- installation quote including type and locations where portable track is being considered
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400953 | Ceiling lift, accessories | MD, NP, OT, PT | GEN | Yes | 1 every 2 years | |
99400949 | Ceiling lift and portable track | MD, NP, OT, PT | GEN | Yes | 1 every 7 years | |
99400952 | Ceiling lift battery, replacement | GEN | Yes | 1 every 2 years | ||
99400950 | Ceiling lift, replacement | MD, NP, OT, PT | GEN | Yes | 1 every 7 years | |
99400951 | Ceiling lift, sling, replacement | MD, NP, OT, PT | GEN | Yes | 2 every 2 years | |
99400324 | Hydraulic lift, powered | MD, NP, OT, PT | GEN | Yes | 1 every 7 years | Justification as to why a standard hydraulic lift will not meet the client's need |
99400817 | Hydraulic lift, powered, recycled | MD, NP, OT, PT | GEN | Yes | 1 every 7 years | |
99400325 | Hydraulic lift, standard | MD, NP, OT, PT | GEN | Yes | 1 every 7 years | |
99400816 | Hydraulic lift, standard, recycled | MD, NP, OT, PT | GEN | Yes | 1 every 7 years | |
99400326 | Hydraulic lift, sling/hammock replacement | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | Yes | 2 every 2 years | |
|
9.7.3 Pole
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400321 | Floor to ceiling pole | MD, NP, OT, PT | GEN | No | 1 every 10 years |
|
9.7.4 Trapeze
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400329 | Trapeze bar and floor stand, purchase | MD, NP, OT, PT | GEN | Yes | 1 per lifetime | |
99401134 | Trapeze bar and floor stand, bariatric, purchase | MD, NP, OT, PT | GEN | Yes | 1 per lifetime | |
99400330 | Trapeze, rental | MD, NP, OT, PT | GEN | Yes | Rented for 1 month at a time |
9.7.5 Transfer
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400309 | Leg lifter | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
99400327 | Transfer belt | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 per year | |
99400328 | Transfer board | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | No | 1 every 10 years | |
|
9.8 Home hospital beds and accessories
For all items, providers must submit the following information for prior approval:
- medical justification is required based on the Home Hospital Bed and Pressure Relieving Surface Assessment Form found on the MS&E forms webpage, available on the Express Scripts Canada NIHB provider and client website
- manufacturer/distributor's invoice must be provided
For clients who require a hospital bed and rails, this must be claimed using the code for electric hospital bed with rails (code 99401125) or electric hospital bed with rails – bariatric (code 99401126). The code for hospital bed rails (code 99401384) is not eligible for coverage concurrently with the codes for electric hospital bed (code 99401382) or electric hospital bed – bariatric (code 99401383), unless claiming these items separately is more cost-effective.
9.8.1 Beds and rails
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99401382 | Electric hospital bed | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 7 years |
|
99401383 | Electric hospital bed - bariatric | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 7 years |
|
99401125 | Electric hospital bed with rails | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 7 years |
|
99401126 | Electric hospital bed with rails - bariatric | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 7 years |
|
99401136 | Rental – electric hospital bed with rails | MD, NP, OT, PT, homecare RN | GEN | Yes | ||
99401384 | Hospital bed rails (pair) | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 7 years | Rails designed for use with a hospital bed that can be used for bed mobility/repositioning, transfers, and/or to prevent falls from the bed |
9.8.2 Mattresses
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99401128 | Standard hospital bed mattress | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 5 years |
|
99401130 | Pressure relief mattress | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 5 years |
|
99401129 | Bariatric bed mattress | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 5 years |
|
99401131 | Bariatric pressure relief mattress | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 5 years |
|
99401385 | Rental – hospital bed mattress | MD, NP, OT, PT, homecare RN | GEN | Yes |
9.8.3 Overlay
- a pressure-relieving surface designed to be used on top of a mattress
- if a hospital bed is being used, a pressure relieving mattress should be considered prior to an overlay
Overlays cannot be claimed with pressure relieving mattress (code 99401130) or bariatric pressure relieving mattress (code 99401131).
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400314 | Non-powered overlay | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 5 years | A medical grade pressure-relieving surface made of a foam, gel, or compartments inflated with air |
99401132 | Powered overlay | MD, NP, OT, PT, homecare RN | GEN | Yes | 1 every 5 years | An inflated medical grade pressure-relieving surface, powered by a motor |
9.9 Uncategorized medical supplies
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400765 | Electronic blood pressure monitor with arm cuff | MD, NP, RM | GEN | No | 1 every 5 years | |
99400877 | Inspection mirror | MD, NP, OT, PT, RN, LPN/RPNTable note 1 | GEN | Yes | 1 per lifetime | |
99400471 | MedicAlert subscription | MD, NP, RN, RRT, LPN/RPNTable note 1 | GEN | Yes | 1 every 5 years | |
99401270 | Thermometer, oral, digital | MD, NP, RN, LPN/RPNTable note 1 | GEN | No | 1 every 5 years | |
|
9.10 Servicing
9.10.1 Repairs
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99400938 | Repair, bath chair lift | GEN | Yes | |||
99400307 | Repair, bathing & toileting aid | GEN | Yes | |||
99400954 | Repair, ceiling lift motor | GEN | Yes | |||
99401135 | Repair, electric hospital bed | GEN | Yes | 6 month warranty | ||
99400293 | Repair, feeding aid | GEN | Yes | |||
99400331 | Repair, lifting/transfer aids | GEN | Yes |
9.10.2 Delivery
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99401137 | Delivery, electric hospital bed/mattress | GEN | Yes | Way bills must be provided | ||
99400930 | Delivery, gender identity | GEN | No | |||
99401266 | Delivery, self-care | GEN | Yes |
9.10.3 Installation
Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
---|---|---|---|---|---|---|
99401381 | Installation – electric hospital bed/mattress | GEN | Yes |