10.0 Low vision equipment and supplies benefits list
Effective date: September 27, 2024
The following Medical Supplies and Equipment (MS&E) list contains low vision 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
- 10.1 General information
- 10.2 Low vision aids
- 10.3 Orientation and mobility aids
- 10.4 Assistive technology aids
- 10.5 Independent living aids
- 10.6 Supplies
- 10.7 Services
- 10.8 Other
10.1 General information
10.1.1 Benefit policies
General information common to all medical supplies and equipment (MS&E) can be found in the general policies.
10.1.2 Prescriber and provider requirements
Prescriptions or recommendations for coverage must be initiated by the health professionals identified as prescribers or recommenders of the item under the NIHB program. 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:
- LVS/CLVT — Low Vision Specialist/Certified Low Vision Therapist
- MD — Physician
- NP — Nurse Practitioner
- O.D. — Doctor of optometry (optometrist)
- OMT — Certified Ophthalmic Technician/Medical Technologist working under Stanton Territorial Health Authority in NWT and Nunavut
- OT — Occupational Therapist
- RN — Registered Nurse
- CVRT — Certified Vision Rehabilitation Therapist
- COMS — Certified Orientation & Mobility Specialist
- ATS — Assistive Technology Specialist
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 medical supplies and equipment or pharmacy provider
10.1.3 Prior approval requirements
General prior approval requirements can be found in the general policies.
10.1.3.1 Low vision equipment and supplies:
To initiate the prior approval process, the Low Vision 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:
For low vision aids, independent living aids, orientation and mobility aids:
- eye assessment from an optometrist or ophthalmologist to determine the type of benefit required (covered under the Vision Care benefit) indicating that the client has a visual acuity in both eyes with proper refractive lenses of 20/70 or lower with the Snellen Chart or equivalent (for example, 20/90, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower) - prescription from an eligible NIHB prescriber for the requested benefit
- when an eye assessment includes a prescription for items that can be prescribed by an optometrist or ophthalmologist, a separate prescription is not required
- diagnosis
- low vision functional assessment report (if available)
- item recommended (make, model and MSRP)
- additional relevant information the prescriber 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.)
For assistive technology aids:
- eye assessment from an optometrist or ophthalmologist to determine the type of benefit required (covered under the Vision Care benefit) indicating that the client has a visual acuity in both eyes with proper refractive lenses of 20/200 or lower with the Snellen Chart or equivalent (for example, 20/220, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower) - prescription from an eligible NIHB prescriber for the requested benefit
- diagnosis
- low vision functional assessment report (if available)
- item recommended (make, model and MSRP)
- additional relevant information the prescriber 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.)
Please note: a prescription that meets the program's prescription requirements for low vision equipment can be used to request the required supplies associated with that equipment. The prescription does not need to list the required supplies.
10.1.3.2 Low vision services:
10.1.3.2.1 Functional assessments
The purpose of functional assessments is to assess a person's current functional status given their visual impairment, to identify any areas where they may require support or assistance, to develop a plan to help them achieve their goals and to determine which visual aids and type of training are needed to maximize the client's independence. The functional assessment must be related to NIHB listed benefit items, and not for the purposes of therapy.
NIHB provides coverage for 4 types of functional assessments: low vision aids, independent living aids, orientation and mobility aids, and assistive technology functional assessments.
To initiate the prior approval process, the Low Vision 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:
- For Low Vision Aids, Independent Living Aids, Orientation and Mobility Aids functional assessments:
- eye assessment from an optometrist or ophthalmologist indicating that the client has a visual acuity in both eyes with proper refractive lenses of 20/70 or lower with the Snellen Chart or equivalent (for example, 20/90, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR,
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower) - diagnosis (that is, low vision impairment)
- additional relevant information the prescriber may have to support the request
- eye assessment from an optometrist or ophthalmologist indicating that the client has a visual acuity in both eyes with proper refractive lenses of 20/70 or lower with the Snellen Chart or equivalent (for example, 20/90, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
- For Assistive Technology functional assessment:
- eye assessment from an optometrist or ophthalmologist indicating that the client has a visual acuity in both eyes with proper refractive lenses of 20/200 or lower with the Snellen Chart or equivalent (for example, 20/220, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR,
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower) - diagnosis (low vision impairment)
- additional relevant information the prescriber may have to support the request
- eye assessment from an optometrist or ophthalmologist indicating that the client has a visual acuity in both eyes with proper refractive lenses of 20/200 or lower with the Snellen Chart or equivalent (for example, 20/220, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
Please note: a functional assessment is required when requesting a training program.
The functional assessment report should include the following:
- assessment of Ocular health
- diagnosis
- visual acuity
- devices trialed
- summary of evaluation
- recommendations (for example, equipment recommended, training program, etc.)
10.1.3.2.2 Training programs
Step #1:
Client receives a low vision functional assessment performed by an NIHB eligible prescriber and obtains an assessment report.
If the client has already undergone a low vision functional assessment prior to submitting a request for a training program, skip step #1.
Step #2:
The following documentation must be submitted to your NIHB regional office:
- A low vision functional assessment report. The functional assessment report must:
- correspond to the requested training program (for example, for orientation and mobility aids training, an orientation and mobility aids functional assessment report is required)
- be completed by an eligible NIHB prescriber
- include the equipment being recommended
- include the duration of the training program and itemize the number of hours of training required per equipment
- If a prior approval form for the coverage of a low vision functional assessment was not submitted to NIHB prior to the request for a training program, the Low Vision prior approval form must also be completed in full and submitted
- An eye assessment from an ophthalmologist or optometrist, if available (covered under the Vision Care benefit)
Note: the low vision functional assessment is a NIHB benefit. For submission requirements, see section 10.1.3.2.1 Functional assessments.
10.1.4 Exclusions
In addition to the general exclusion policy listed in the general policies, the following items are excluded from the Low Vision benefit and are not considered for coverage or appeal under the NIHB program:
- computer and printer
- cell phone
- regular watch
- wi-fi service and data plan
- internet coverage
- landline telephone service
- eye assessment (covered under the Vision care benefit)
10.1.5 Warranties
Providers must honour the manufacturer's warranty.
10.1.6 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
- 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.
10.1.7 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.
An original prescription may be used for initial and replacement requests of low vision equipment and supplies when ALL of the following criteria are met:
- the equipment/supply was initially covered by the NIHB program
- the client's functional status remains the same
- the item is eligible for replacement as per its recommended replacement guidelines
A copy of the prescription must be kept in the client's file at the provider's office for all replacements.
All other requests for replacement require a new prescription.
For more general information, please see section 1.12 Recommended replacement guidelines.
10.1.7.1 Early replacement requirements
Coverage requests for an early replacement requires prior approval and a new prescription or written justification from an eligible NIHB prescriber to support 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 vision status, 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.
10.1.8 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 delivery costs, exchange rate)
- dispensing of the benefit, which includes any required adjustments or fittings
- setup and installation
10.1.9 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.
10.2 Low vision aids
10.2.1 Eligibility criteria
- visual acuity in both eyes with proper refractive lenses is 20/70 or less with the Snellen Chart or equivalent (for example, 20/90, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
10.2.2 Magnifier
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99400868 | Optical magnifiers | LVS/CLVT, , MD, RN, O.D., OMT, OT, NP | GEN | No | 1 every 2 years | |
| 99401390 | Handheld digital magnifier | LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 2 years | For example, the Magno Digital Portable Magnifier, the Explore Kit, the Ruby 10 HD magnifier, etc. |
| 99400869 | Magnifier, illuminated head | LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 2 years | |
| 99400870 | Magnifier, illuminated handle | LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 2 years | |
| 99400871 | Microscope | LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 3 years | |
| 99400872 | Telescope or monocular | LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 3 years | |
| 99401389 | Loupe | LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | No | 1 every 3 years |
10.3 Orientation and mobility aids
10.3.1 Eligibility criteria
- visual acuity in both eyes with proper refractive lenses is 20/70 or less with the Snellen Chart or equivalent (for example, 20/90, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
10.3.2 Orientation and mobility
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401408 | GPS technology | LVS/CLVT, O.D., OMT, COMS | GEN | Yes | 1 every 5 years | For example, talking GPS such as the Stellar Trek |
| 99400874 | White cane | LVS/CLVT, MD, O.D., OMT, COMS, NP, RN | GEN | Yes | 1 per year | |
| 99400875 | White cane tip | LVS/CLVT, MD, O.D., OMT, COMS, RN, NP | GEN | Yes | 3 per year |
10.4 Assistive technology aids
10.4.1 Eligibility criteria
- visual acuity in both eyes with proper refractive lenses is 20/200 or less with the Snellen Chart or equivalent (for example, 20/220, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
10.4.2 Assistive technology
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401392 | Desktop technology | ATS, LVS/CLVT | GEN | Yes | 1 every 5 years | Includes CCTV (for example, Vario digital magnifier, Reveal 16 magnifier) |
| 99401393 | Software | ATS, LVS/CLVT | GEN | Yes | 1 every 2 years | For example, Text to Speech, JAWS software ("Job Access With Speech"), Zoomtext Magnifier, etc. The software (original license) and the software maintenance agreement (SMA) can be requested initially. After two years the SMA can be covered once again |
| 99401394 | Optical character recognition (OCR) | ATS, LVS/CLVT, | GEN | Yes | 1 every 4 years | For example, ClearReader, LyriQ Reader, the Penfriend |
| 99401395 | Brailler | CVRT, ATS, LVS/CLVT | GEN | Yes | 1 every 5 years | Includes manual braillers (for example, the Perkins Brailler), as well as electronic braille display devices (for example, the Mantis Braille Display, the Notetaker, the Braillenote Touch, etc.) |
10.5 Independent living aids
10.5.1 Eligibility criteria
- visual acuity in both eyes with proper refractive lenses is 20/70 or less with the Snellen Chart or equivalent (for example, 20/90, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
10.5.2 Independent living
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401401 | Accessible phone | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 5 years | Non-cellular phones, for example, the Geemarc AmpliCL phone, the Panasonic cordless phone, the Ameriphone, etc. |
| 99401402 | Recording device | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 5 years | For example, Sony ICD recorder |
| 99401403 | Digital audio player | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 5 years | Audio book player |
| 99401404 | Watch | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 3 years | Includes braille tactile watch and talking low vision watch, for example, Ladies/Men Talk Date Time watch |
| 99401405 | Clock | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 5 years | Talking low vision clock, for example, Talking Clock with Alarm and Date, talking Calendar Clock White Button, etc. |
| 99401406 | Talking blood pressure monitor | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 5 years | |
| 99401407 | Talking thermometer | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 1 every 5 years | |
| 99401396 | Braille paper | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | No | 1 every 3 years | 1 packet of 250 braille sheets |
| 99401397 | Braille labeller | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | No | 1 every 5 years | For example, the Braille Labeller (plastic), labelling products, etc. |
| 99401398 | Braille labeller tape | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | No | 1 per year | For example, Dymo clear tape |
10.6 Supplies
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401419 | Accessories | CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP, COMS, ATS | GEN | Yes | 1 claim every 2 years | For example, headphones, charging bank, stand, carrying case, keyboard, remote, tape measure, etc. |
10.7 Services
10.7.1 Eligibility criteria for functional assessments
- For low vision aids, independent living aids, orientation and mobility aids functional assessments
- visual acuity in both eyes with proper refractive lenses is 20/70 or less with the Snellen Chart or equivalent, (for example, 20/90, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
- visual acuity in both eyes with proper refractive lenses is 20/70 or less with the Snellen Chart or equivalent, (for example, 20/90, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
- For assistive technology functional assessment
- visual acuity in both eyes with proper refractive lenses is 20/200 or less with the Snellen Chart or equivalent (for example, 20/220, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
OR
the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
- visual acuity in both eyes with proper refractive lenses is 20/200 or less with the Snellen Chart or equivalent (for example, 20/220, light perception (LP), no light perception (NLP), hand movements (HM), etc.)
10.7.2 Functional assessments
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401411 | Functional assessment (FA) – Low vision aids | LVS/CLVT, | LVS/CLVT | Yes | 1 assessment every 2 years | $150/hr for a maximum of 2 hours |
| 99401410 | Functional assessment (FA)– Orientation and mobility aids | LVS/CLVT, COMS | LVS/CLVT, COMS | Yes | 1 assessment every 2 years | $150/hr for a maximum of 2 hours |
| 99401412 | Functional assessment (FA) -Assistive technology aids | LVS/CLVT, CVRT, ATS | LVS/CLVT, CVRT, ATS | Yes | 1 assessment every 2 years | $150/hr for a maximum of 2 hours |
| 99401413 | Functional assessment (FA) – Independent living aids | LVS/CLVT, CVRT | LVS/CLVT, CVRT | Yes | 1 assessment every 2 years | $150/hr for a maximum of 2 hours |
10.7.3 Eligibility criteria for training programs
- client must have a low vision functional assessment report. The functional assessment must be performed by an NIHB-eligible prescriber
- the report must indicate which equipment is being prescribed for the client
- the report must indicate the need for training to enable the client to effectively use the recommended equipment
10.7.4 Training programs
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401415 | Training program (TP) – Low vision aids | LVS/CLVT, | LVS/CLVT | Yes | 1 training program per client | $150 per hour, for a maximum of 4 hours Follows a low vision aids functional assessment |
| 99401414 | Training program (TP) – Orientation and mobility aids | LVS/CLVT, COMS | LVS/CLVT, COMS | Yes | 1 training program per client | $150 per hour, for a maximum of 18 hours Follows an orientation and mobility aids functional assessment |
| 99401416 | Training program (TP) – Assistive technology aids | LVS/CLVT, CVRT, ATS | LVS/CLVT, CVRT, ATS | Yes | 1 training program per client | $150 per hour, for a maximum of 12 hours Follows an assistive technology aids functional assessment |
| 99401417 | Training program (TP) – Independent living aids | LVS/CLVT, CVRT | LVS/CLVT, CVRT | Yes | 1 training program per client | $150 per hour, for a maximum of 6 hours Follows an independent living aids functional assessment |
10.7.5 Servicing
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99401418 | Repairs | Yes | Minimum of 12 months warranty on repairs | |||
| 99401267 | Delivery, low vision | Delivery of equipment to client |
10.8 Other
| Item code | Item name | Prescriber | Provider | Prior approval required | Recommended replacement guidelines | Additional details |
|---|---|---|---|---|---|---|
| 99400873 | Coloured filters | LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | 2 pairs every 2 years | |
| 99400876 | Face cradle, rental | LVS/CLVT, MD, RN, O.D., OMT, OT, NP | GEN | Yes | Post-op recovery equipment for vitrectomy surgery |