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Medical Supplies and Equipment
General Benefits and Criteria

General Benefit Categories

Bathing and Toileting Aids
Cushions and Protectors
Environmental Aid
- Dressing Aids
- Feeding Aids
- Lifting and Transfer Aids
- Miscellaneous Supplies and Equipment
Mobility Aids
- Walking Aids and Accessories
- Wheelchairs, wheelchair cushions and parts
Ostomy Supplies and Devices
Urinary Supplies and Equipment
- Catheter Supplies and Equipment
- Incontinence Supplies
Wound Dressing Supplies
- Adhesive Tapes and Dressing Strips
- Bandages
- Dressings
- Other Dressings

See the General Benefit List for a full list of eligible products, prior approval requirements and frequency limitations.

Prescriber/Provider Requirements

General MS&E benefits must be prescribed by a physician.
General MS&E benefits must be provided by a recognized pharmacy or medical supply and equipment provider.

Prior Approval Process

When a prior approval is required, the provider must contact the First Nations and Inuit Health Branch (FNIHB) Regional Office to initiate the process. The Non-Insured Health Benefits General Medical Supplies and Equipment Prior Approval Form (PDF version) must be completed. In addition to the form, this documentation is required to support the request:

The prescription; and
Other supporting medical documentation (as required).

If a prior approval is granted, a Prior Approval (PA) number will be provided for billing purposes. Only then should the provider proceed with the fabrication/ fitting/dispensing of the item. If prior approval is not granted the provider will be advised of the reason.

On the prior approval form, providers are required to include a cost estimate of the delivery codes 99400819 and 99400820.

In the case of a repair, although a prescription is no longer required, the Non-Insured Health Benefits (NIHB) General Medical Supplies and Equipment (MS&E) Prior Approval Form must be completed and include the reason for the request.

Note to Ontario Providers: Providers must first contact the Assistive Devices Program (ADP) of the Ontario Ministry of Health for coverage of these benefits for Ontario residents.

Exclusions

Exclusions are items that are not listed as benefits under the NIHB Program and are not available through the exception process. These items are therefore not considered for coverage under the NIHB Program and are not subject to the NIHB appeal process. Under the category of general MS&E benefits, these include, but are not limited to:

Items used exclusively for sports, work or education;
Items for cosmetic purposes;
Scooters;
Hospital beds and mattresses; and
Grab bars permanently fixed.

Quantity Limitations

Items that have an annual quantity limitation must be provided and billed for no more than a three-month period at a time. This applies to items claimed with or without a prior approval.

General Benefit List

List Terminology

Item Description:: Items are listed within general and specific categories (for example: Audiology), in alphabetical order by category and item.
Item Code:: The 8-digit code that must be submitted to First Canadian Health for billing purposes.
Prior Approval:: Identifies by general category, or by item within the category, whether prior approval must be obtained by the provider before dispensing the item.

Bathing and Toileting Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Bath chair lift manual (water powered)	99400474	Yes	5 years
Bedpan	99400294	No	3 years
Bench/stool, adjustable/seat/arms	99400295	Yes	5 years
Commode, standard, purchase	99400296	Yes	5 years
Commode, standard, rental	99400297	Yes
Elevated (raised) toilet seat (standard)	99400298	No	3 years
Elevated (raised) toilet seat (with arms)	99400299	Yes	3 years
Grab bar for tub (non-permanent)	99400649	No	3 years
Grab bar toilet (non-permanent)	99400300	No	5 years
Mat, tub, non-slip	99400301	No	2 years
Safety frame for toilet	99400302	Yes	5 years
Shower-commode chair	99400303	Yes	5 years
Tub transfer bench	99400304	Yes	5 years
Tub transfer board	99400305	Yes	5 years
Urinal	99400306	No	3 years
Bathing & Toileting Aid Benefit Repairs	99400307	Yes

Cushions and Protectors

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Elbow protector	99400308	No	5 years
Foot elevator	99400309	No	5 years
Heel protector, 1 pair	99400310	No	1 year
Invalid ring	99400311	No	3 years
Cushion moulded back	99400312	Yes	10 years
Cushion moulded seat	99400313	Yes	10 years
Pad, Pressure relief pad-bed, foam	99400314	Yes	3 years
Pad, Pressure relief pad, wedge	99400315	Yes	3 years
Quad knee separator	99400316	No	3 years
Cushion, Moulded cushion repairs	99400470	Yes

Dressing Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Button hook	99400277	No	5 years
Dressing hook	99400278	No	5 years
Long handle shoe horn	99400279	No	5 years
Reacher	99400280	No	5 years
Sock/stocking aid (previously quad grip aid)	99400281	No	5 years

Feeding Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Feeding pump rental	99400282	Yes
Feeding pump purchase	99400283	Yes	5 years
Feeding pump pole (IV pole)	99400284	Yes	Lifetime
Feeding pump supplies, bags 1000ml (liquid nutrition not a benefit)	99400285	No	400 per year
Feeding pump supplies, bags 1500ml (liquid nutrition not a benefit)	99400650	No	400 per year
Gravity feeding supplies, delivery sets w/bags	99400651	No	400 per year
Gravity feeding supplies, delivery sets without bags	99400652	No	400 per year
Gravity feeding supplies, bags	99400653	No	400 per year
Gravity feeding supplies, rigid containers	99400654	No	24 per year
Other enteral feeding supplies, gastrostomy catheters/tubes	99400655	No	12 per year
Other enteral feeding supplies, nasogastric tube	99400286	No	24 per year
Other enteral feeding supplies, extension sets	99400656	No	12 per year
Other enteral feeding supplies, adaptors/plugs	99400657	No	12 per year
Built-up (padded) handle OR universal cuff	99400287	No	5 years
Food guard	99400288	No	5 years
Mat, feeding aids, non-slip	99400289	No	5 years
Specialized utensils, fork OR spork	99400290	No	5 years
Specialized utensils, knife	99400291	No	5 years
Specialized utensil, spoon	99400292	No	5 years
Feeding Aid Benefit Repairs	99400293	Yes

Miscellaneous Supplies and Equipment

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Breast pump, manual	99400317	Yes	Lifetime
Breast pump, electric, rental	99400658	Yes
Gloves, latex/vinyl, 100/box	99400318	No	12 boxes per year
Irrigation solution (large volume, pour bottle)	99400319	No
Irrigation syringe (60cc funnel tip)	99400320	No	24 per year
Medic Alert Bracelet (standard)	99400471	Yes	Lifetime
Other recycled MS&E; items	99400818	Yes

Lifting and Transfer Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Floor to ceiling pole	99400321	Yes	Lifetime
Grab bar, for bed, non-permanent, purchase	99400322	Yes	10 years
Grab bar, for bed, non-permanent, rental	99400323	Yes
Lift, manual	99400475	Yes	10 years
Lift, hydraulic (powered)	99400324	Yes	10 years
Lift, hydraulic, standard	99400325	Yes	10 years
Recycled lift hydraulic, powered	99400817	Yes	10 years
Recycled lift hydraulic, standard	99400816	Yes	10 years
Sling/hammock	99400326	Yes	2 per 2 years
Transfer Belt	99400327	No	1 year
Transfer Board	99400328	No	10 years
Trapeze, purchase	99400329	Yes	Lifetime
Trapeze, rental	99400330	Yes
Lifting/transfer Aid Benefit Repairs	99400331	Yes

Mobility Aids: Walking Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Cane, aluminium adjustable, single	99400332	No	Lifetime
Cane, aluminium adjustable, quad	99400333	No	Lifetime
Crutches, axillary - purchase, pair	99400335	No	2 years
Crutches, axillary - rental, pair	99400336	Yes
Crutches, specialized, purchase, pair (forearm)	99400337	Yes	5 years
Delivery mobility service	99400819	Yes
Recycled walker, standard	99400812	Yes	5 years
Recycled wheeled walker	99400813	Yes	5 years
Walker, standard-purchase	99400338	Yes	5 years
Walker, standard-rental	99400339	Yes
Walker, wheeled-purchase	99400340	Yes	5 years
Walker, wheeled-rental	99400341	Yes
Walker repairs	99400342	Yes

Mobility Aids: Walking Aids - Accessories

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Crutch, hand grips	99400343	No	2 per year
Crutch, pads	99400344	No	2 per year
Tips (ice picks)	99400345	No	1 per 2 years
Tips (rubber)	99400346	No	1 per year
Walker glide brakes	99400347	No	2 years
Walker wheels	99400348	No	2 years

Mobility Aids: Wheelchairs

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Recycled manual wheelchair	99400814	Yes	5 years
Wheelchair, Manual, conventional, purchase	99400349	Yes	5 years
Wheelchair, Manual, conventional, rental	99400350	Yes

Mobility Aids: Wheelchair Cushions and Parts (Back Support)

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Back, complex moulded (foam in place), child	99400659	Yes	3 years
Back, complex moulded (foam in place), adult	99400353	Yes	4 years
Back, flat, child	99400660	Yes	2 years
Back, flat, adult	99400357	Yes	3 years
Back, flat, cover, child	99400661	Yes	2 years
Back, flat, cover, adult	99400662	Yes	2 years
Back, sculptured custom-shaped, child	99400663	Yes	2 years
Back, sculptured custom-shaped, adult	99400358	Yes	4 years
Back, sculptured, cover, child	99400664	Yes	2 years
Back, sculptured, cover, adult	99400359	Yes	2 years
Back, simple moulded (foam in place), child	99400665	Yes	3 years
Back, simple moulded (foam in place), adult	99400360	Yes	3 years

Mobility Aids: Wheelchair Cushions and Parts (Seats)

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Pelvic stabilizer, one, child	99400666	Yes	3 years
Pelvic stabilizer, one, adult	99400367	Yes	5 years
Pelvic stabilizer, pair, child	99400667	Yes	3 years
Pelvic stabilizer, pair, adult	99400368	Yes	5 years
Seat, complex designed, custom cover, child	99400668	Yes	2 years
Seat, complex designed, custom cover, adult	99400361	Yes	2 years
Seat, custom moulded (foam in place), adult only	99400363	Yes	3 years
Seat, custom-shaped, child	99400669	Yes	2 years
Seat, custom-shaped, adult	99400364	Yes	3 years
Seat, flat, child	99400670	Yes	2 years
Seat, flat, adult	99400671	Yes	3 years
Seat, sculptured, child	99400672	Yes	2 years
Seat, sculptured, adult	99400369	Yes	3 years
Wheelchair cushions (back & seat) repairs	99400673	Yes

Mobility Aids: Wheelchair Cushions and Parts (Wheelchair Parts)

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Arm rest, fixed support, one piece	99400372	Yes
Arm rest, fixed support, one piece, pads	99400674	Yes
Arm rest, fixed support, one piece, hardware	99400675	Yes
Arm rest, fixed support, multi component	99400676	Yes
Arm rest, fixed support, multi components, pad	99400677	Yes
Arm rest, fixed support, multi components, hardware	99400678	Yes
Arm rest, movable	99400679	Yes
Axle plate	99400373	Yes
Back rest, child	99400680	Yes
Back rest, adult	99400374	Yes
Calf board, child	99400681	Yes
Calf board, adult	99400682	Yes
Castor	99400376	Yes
Castor fork	99400377	Yes
Castor housing	99400378	Yes
Castor housing dust cover	99400379	Yes
Castor plate	99400380	Yes
Crossbrace	99400381	Yes
Elevating legrest/footrest	99400382	Yes
Footplate	99400383	Yes
Footplate extension	99400683	Yes
Footrest, fixed, child	99400684	Yes
Footrest, fixed, adult	99400685	Yes
Footrest, adjustable, child	99400686	Yes
Footrest, adjustable, adult	99400687	Yes
Footrest, "L" shaped, child	99400688	Yes
Footrest, "L" shaped, adult	99400689	Yes
Foot box, child	99400690	Yes
Foot box, adult	99400691	Yes
Foot pocket, child	99400692	Yes
Foot pocket, adult	99400693	Yes
Frontrigging	99400384	Yes
Growable frame	99400385	Yes
Handrim	99400386	Yes
Head rest, complex designed, child	99400694	Yes
Head rest, complex designed, adult	99400695	Yes
Head rest, contoured, child	99400696	Yes
Head rest, contoured, adult	99400697	Yes
Head rest flat, adjustable, child	99400700	Yes
Head rest flat, adjustable, adult	99400701	Yes
Heel loop	99400387	Yes
Interfacing/mounting, strap, children only	99400702	Yes
Interfacing/mounting, simple seat	99400703	Yes
Interfacing/mounting, simple back	99400704	Yes
Interfacing/mounting, simple	99400705	Yes
Interfacing mounting, complex	99400706	Yes
Neck rest, adjustable, child	99400707	Yes
Neck rest, adjustable, adult	99400708	Yes
Neck rest with headrest, adjustable, child	99400709	Yes
Neck rest with headrest, adjustable, adult	99400710	Yes
Pommel, fixed, child	99400711	Yes
Pommel, fixed, adult	99400712	Yes
Pommel, removable, child	99400713	Yes
Pommel, removable, adult	99400714	Yes
Push handle/backrest tube	99400388	Yes
Push to lock wheel locks	99400389	Yes
Quick-release axle pin	99400390	Yes
Rear Wheel Hub	99400391	Yes
Restraint, ankle	99400715	Yes
Restraint, butterfly	99400716	Yes
Restraint, calf	99400375	Yes
Restraint, chest	99400717	Yes
Restraint, complex	99400718	Yes
Restraint, pads	99400719	Yes
Restraint, pelvic, child	99400720	Yes
Restraint, pelvic, adult	99400392	Yes
Seat sling	99400393	Yes
Spokes	99400394	Yes
Tire	99400395	Yes
Tray, elevating, child	99400721	Yes	1 per 2 years
Tray, elevating, adult	99400722	Yes	1 per 5 years
Tray, standard, child	99400723	Yes	1 per 2 years
Tray, standard, adult	99400724	Yes	1 per 5 years
Tray, tilting, child	99400725	Yes	1 per 2 years
Tray, tilting, adult	99400726	Yes	1 per 5 years
Wheel lock	99400396	Yes
Wheelchair Repairs	99400397	Yes

Ostomy Supplies and Devices

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Absorbent flakes/ capsules	99400409	Yes	2 pkgs of 90 per year
Adhesive removers	99400476	Yes	6 boxes per year
Belt, ostomy	99400400	Yes	3 per year
Closed pouch two-piece colostomy/ileostomy system	99400414	Yes	120 per 3 months
Continent diversion dressing - 4"x4" - clean gauze (for clients with a continent diversion and are in lieu of pouches)	99400728	Yes	400 per 3 months
Convex inserts	99400401	Yes	30 per 3 months
Drainable pouch two-piece colostomy/ileostomy system	99400415	Yes	30 per 3 months
Filters	99400402	Yes	2 boxes of 50 per year
Flange for two-piece ostomy system	99400742	Yes	50 per 3 months
Flange, convex for two-piece ostomy system	99400743	Yes	50 per 3 months
Gel lubricant	99400403	Yes	12 per year
Irrigation kit for ostomies	99400737	Yes	1 per 3 months
Mucus dispersant	99400782	No
Odor control product concentrate (for inside pouch only)	99400404	Yes	12 per year
One-piece closed-end colostomy pouch with seal	99400729	Yes	120 per 3 months
One-piece drainable colostomy/ileostomy pouch with adhesive or Karaya	99400406	Yes	30 per 3 months
One-piece drainable colosotomy/ileostomy pouch convex	99400730	Yes	50 per 3 months
One-piece urostomy pouch	99400731	Yes	50 per 3 months
One-piece urostomy pouch, convex	99400732	Yes	50 per 3 months
Ostomy barrier powder	99400398	Yes
Ostomy irrigation sleeves	99400738	Yes	30 per 3 months
Plastic faceplate	99400739	Yes	3 per 3 months
Pouch cover	99400783	Yes	4 per year
Protective skin wipes/spray	99400411	Yes	4 boxes per year
Skin barrier/wafer	99400410	Yes	50 per 3 months
Skin barrier paste	99400408	Yes	3 per 3 months
Stoma cone for irrigation	99400412	Yes	6 cones per year
Urostomy pouch for two-piece system	99400745	Yes	30 per 3 months

Catheter Supplies and Equipment

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Adaptors/connectors/ closures (catheters)	99400417	Yes
Adhesive strips, generic, for external catheters	99400747	Yes
Catheter plug	99400424	Yes
Catheter tray, catheterization	99400425	Yes
Catheter tray, irrigation	99400426	Yes
Drainage bags, leg straps	99400427	Yes
Drainage bags, w/tubing, disposable	99400428	Yes
Drainage bags, w/tubing, reusable	99400429	Yes
Drainage bags, w/out tubing, disposable	99400430	Yes
Drainage bags, w/out tubing, reusable	99400431	Yes
Drainage night bag, reusable	99400433	Yes
Extension tubing	99400434	Yes
External catheter with removable tip	99400748	Yes
External catheters, disposable	99400418	Yes
External catheters, reusable	99400419	Yes
Indwelling catheters	99400420	Yes
Intermittent catheters, disposable	99400421	Yes
Irrigation catheters	99400423	Yes
Irrigation solution	99400319	No
Irrigation syringe	99400320	No	24 per year
Lubricating jelly	99400435	Yes
Suspensory belt/ sheath	99400413	Yes

Incontinence Supplies

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Delivery incontinence items	99400820	Yes
Diaper disposable, child over 2 years of age	99400752	Yes	450 per 3 months
Diaper disposable, large adult	99400751	Yes	450 per 3 months
Diaper disposable, large/extra large, child over 2 years of age	99400753	Yes	450 per 3 months
Diaper disposable, medium, adult	99400440	Yes	450 per 3 months
Diaper disposable, small, youth, adult	99400750	Yes	450 per 3 months
Diaper/brief reusable, adult	99400441	Yes
Diapers (undergarments) reusable, child over 2 years of age	99400754	Yes
Liners, disposable	99400438	Yes
Liners, reusable	99400439	Yes
Pant, briefs, disposable	99400436	Yes	450 per 3 months
Pant, (brief) mesh, reusable	99400755	Yes	3 per month
Underpads, disposable	99400442	Yes
Underpads, reusable	99400443	Yes

Adhesive Tapes and Dressing Strips

Item Description	Item Code	Prior Approval
Adhesive suture strips	99400446	Yes
Adhesive tape, hypoallergenic	99400444	No
Adhesive tape, non-hypoallergenic	99400445	No
Montgomery ties (set)	99400447	No

Bandages

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Conforming gauze bandages	99400448	No
Elastic tensor bandages	99400449	No	8 per year
Impregnated venous ulcer bandages	99400450	No
Tubular net dressing	99400451	No

Dressings

Item Description	Item Code	Prior Approval
Absorptive dressing	99400452	No
Alginates/Hydrofibres dressing	99400454	Yes
Charcoal dressing	99400455	Yes
Composite dressing	99400811	Yes
Foam dressing medicated/non-medicated	99400456	Yes
Gauze, abdominal pad dressing	99400457	No
Gauze, non-sterile dressing, 2x2	99400196	No
Gauze, non-sterile dressing, 3x3	99400756	No
Gauze, non-sterile dressing, 4x4	99400458	No
Gauze, non-sterile dressing, 6x8	99400757	No
Gauze, sterile dressing, 2x2	99400459	No
Gauze, sterile dressing, 3x3	99400759	No
Gauze, sterile dressing, 4x4	99400760	No
Gel/hydrogel dressing	99400460	Yes
Hydrocolloid dressing	99400461	Yes
Iodine dressing	99400810	Yes
Non-adherent dressing, impregnated	99400462	Yes
Non-adherent dressing, non-impregnated	99400463	Yes
Silver dressing	99400809	Yes
Transparent film dressings, (adhesive)	99400464	Yes
Transparent film dressings, (spray-on)	99400465	Yes

Other Dressings

Item Description	Item Code	Prior Approval
Eye pads	99400466	No
Eye shield	99400467	No
Packing strips	99400468	No
Sterile saline, pour bottle	99400469	No


	Last Updated: 2006-03-20		Important Notices

Medical Supplies and Equipment General Benefits and Criteria