2.0 Medical Supplies and Equipment
General Benefits and Criteria

Help on accessing alternative formats, such as Portable Document Format (PDF), Microsoft Word and PowerPoint (PPT) files, can be obtained in the alternate format help section.

General Benefit Categories

• 2.1 Bathing and Toileting Aids
• 2.2 Cushions and Protectors
• 2.3 Environmental Aids
  • 2.3.1 Dressing Aids
  • 2.3.2 Feeding Aids
  • 2.3.3 Miscellaneous Supplies and Equipment
  • 2.3.4 Lifting and Transfer Aids
    
    
• 2.4 Mobility Aids
  • 2.4.1 Walking Aids and Accessories
  • 2.4.2 Wheelchairs, wheelchair cushions and parts
  • 2.4.3 Miscellaneous
    
    
• 2.5 Ostomy Supplies and Devices
• 2.6 Urinary Supplies and Equipment
  • 2.6.1 Catheter Supplies and Equipment
  • 2.6.2 Incontinence Supplies
    
    
• 2.7 Wound Dressing Supplies
  • 2.7.1 Adhesive Tapes and Dressing Strips
  • 2.7.2 Bandages
  • 2.7.3 Dressings
  • 2.7.4 Other Dressings
    
    
• 2.8 Low Vision Aids

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

For information on policies regarding the provision of general equipment and supplies, please consult the Provider Guide for Medical Supplies and Equipment.

General Benefit List

2.1 Bathing and Toileting Aids

Table - Bathing and Toileting Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Bath Chair	99400295	Yes	5 years
Bathing & Toileting Aid Benefit Repairs	99400307	Yes
Bedpan	99400294	No	3 years
Commode, standard, purchase	99400296	Yes	5 years
Commode, 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
Inspection mirror	99400877	Yes	Lifetime
Mat, tub, non-slip	99400301	No	2 years
Safety frame for toilet	99400302	Yes	5 years
Shower-commode chair	99400303	Yes	5 years
Toilet tissue aid	99400878	Yes	5 years
Tub transfer bench	99400304	Yes	5 years
Tub transfer board	99400305	Yes	5 years
Urinal	99400306	No	3 years

2.2 Cushions and Protectors

Table - Cushions & Protectors

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Elbow protector	99400308	No	5 years
Heel protector, 1 pair	99400310	No	1 years
Invalid ring	99400311	No	3 years
Leg Lifter	99400309	No	5 years
Pad, Pressure relief pad, wedge	99400315	Yes	3 years
Quad knee separator	99400316	No	3 years

2.3 Environmental Aids

2.3.1 Dressing Aids

Table - 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

2.3.2 Feeding Aids

Table - Feeding Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Built-up (padded) handle OR universal cuff	99400287	No	5 years
Enteral feeding buttons	99400767	Yes	3 per year
Enteral feeding supplies, adaptors/plugs	99400657	No	12 per year
Feeding Aid Benefit Repairs	99400293	Yes
Feeding pump bags	99400285	No	250 per year
Feeding pump rental	99400282	Yes
Feeding pump purchase	99400283	Yes	5 years
Feeding pump pole (IV pole)	99400284	Yes	Lifetime
Food guard	99400288	No	5 years
Gravity feeding supplies, delivery sets w/bags	99400651	No	250 per year
Gravity feeding supplies, delivery sets without bags	99400652	No	250 per year
Gravity feeding supplies, bags	99400653	No	250 per year
Gravity feeding supplies, rigid containers	99400654	No	24 per year
Mat, feeding aids, non-slip	99400289	No	5 years
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
Specialized utensils, fork OR spork	99400290	No	5 years
Specialized utensils, knife	99400291	No	5 years
Specialized utensil, spoon	99400292	No	5 years
Syringe Luer Lock, disposable, 3cc	99400530	No	52 per year
Syringe Luer Lock, disposable, 5cc	99400535	No	52 per year
Syringe Luer Lock, disposable, 10cc	99400539	No	52 per year
Syringe Luer Lock, disposable, 20cc	99400548	No	52 per year

2.3.3 Miscellaneous Supplies and Equipment

Table - 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	52 per year
Medic Alert Bracelet (standard)	99400471	Yes	Lifetime
Other recycled MS&E items	99400818	Yes

2.3.4 Lifting and Transfer Aids

Table - Lifting & Transfer Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Floor to ceiling pole	99400321	Yes	Lifetime
Grab bar, bed, purchase	99400322	Yes	10 years
Grab bar, bed, rental	99400323	Yes
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

2.4 Mobility Aids

2.4.1 Mobility Aids: Walking Aids

Table - Mobility Aids: Walking Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Cane, 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
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

2.4.2 Mobility Aids: Walking Aids - Accessories

Table - 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
Skis for walker set of 2	99400879	No	2 years
Tips (ice picks)	99400345	No	1 per 2 years
Tips (rubber)	99400346	No	1 per year
Tray/pouch for walker	99400880	No	5 years
Walker glide brakes	99400347	No	2 years
Walker wheels	99400348	No	2 years

2.4.2 Mobility Aids: Wheelchairs

Table - Mobility Aids: Wheelchairs

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Power wheelchair, purchase	99400785	Yes	5 years
Recycled manual wheelchair	99400814	Yes	5 years
Recycled power wheelchair, purchase	99400815	Yes	5 years
Wheelchair, Manual, purchase	99400349	Yes	5 years
Wheelchair, Manual, rental	99400350	Yes

2.4.2 Mobility Aids: Wheelchair Cushions and Parts (Back Support)

Table - Mobility Aids: Wheelchair Cushions & Parts (Back Support)

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Back, support, child	99400660	Yes	2 years
Back, support, adult	99400357	Yes	3 years
Cover/back support, child	99400661	Yes	2 years
Cover/back support, adult	99400662	Yes	2 years

2.4.2 Mobility Aids: Wheelchair Cushions and Parts (Seats)

Table - Mobility Aids: Wheelchair Cushions & Parts (Seats)

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Cover for seat, child	99400668	Yes	2 years
Cover for seat, adult	99400361	Yes	2 years
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, adult	99400363	Yes	3 years
Seat, child	99400669	Yes	2 years
Wheelchair cushions (back & seat) repairs	99400673	Yes

2.4.2 Mobility Aids: Wheelchair Cushions and Parts (Wheelchair Parts)

Table - Mobility Aids: Wheelchair Cushions & Parts (Wheelchair Parts)

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Amputation board	99400881	Yes	5 years
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
Batteries power wheelchair, pair	99400882	Yes	1 year
Brakes	99400883	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	99400684	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	99400694	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
Positioning, ankle	99400715	Yes
Positioning, butterfly	99400716	Yes
Positioning, calf	99400375	Yes
Positioning, chest	99400717	Yes
Positioning, complex	99400718	Yes
Positioning, pads	99400719	Yes
Positioning, pelvic belt, child	99400720	Yes
Positioning, pelvic belt, adult	99400392	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
Seat sling/rigit	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

2.4.3 Mobility Aids: Miscellaneous

Table - Mobility Aids: Miscellaneous

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Delivery of equipment	99400819	Yes

2.5 Ostomy Supplies and Devices

Table - Ostomy Supplies & Devices

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Absorbent flakes/ capsules	99400409	Yes	2 pkgs of 90 per year
Adaptor/connector/clamp ostomy/cat	99400763	Yes	12 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
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
Moldable ring seals	99400884	Yes
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	3 per 3 months
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

2.6 Urinary Supplies and Equipment

2.6.1 Catheter Supplies and Equipment

Table - Catheter Supplies & 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 night bags, disposable	99400428	Yes	52 per year
Drainage leg bags, reusable	99400429	Yes	4 per year
Leg bags, w/out tubing, disposable	99400430	Yes	52 per year
Leg bags, with tubing, disposable	99400431	Yes	52 per year
Leg straps for drainage bags	99400427	Yes	52 per year
Extension tubing	99400434	Yes	52 per year
External catheters, disposable	99400418	Yes	90 per 3 months
External catheters, reusable	99400419	Yes
Indwelling catheters	99400420	Yes	4 per 3 months
Intermittent catheters, disposable	99400421	Yes	36 per 3 months
Irrigation catheters	99400423	Yes
Irrigation solution	99400319	No
Irrigation syringe	99400320	No	52 per year
Lubricating jelly/box, single use	99400885	Yes	4 per 3 months
Lubricating jelly tube	99400435	Yes	12 per 3 months
Night bottle, reusable	99400433	Yes	4 per year

2.6.2 Incontinence Supplies

Table - Incontinence Supplies

Old Item Number	Item Description	New Item Number	Price for Province	Price for Territories	Prior Approval	Replacement Guidelines
99400436	Adult Diapers/Pull-Ups, Small or Medium	99401087	$1.24	$1.42	Yes	450 per 3 months
	Adult Diapers/Pulls, Large or Extra Large	99401088	$1.33	$1.52	Yes	450 per 3 months
	Diapers/Pull-Ups, XXX Large	99401089	$1.51	$1.73	Yes	450 per 3 months
99400750	Adult Diaper/Tabs, Small or Medium	99401090	$0.99	$1.13	Yes	450 per 3 months
	Adult Diaper/Tabs, Large or Extra Large	99401091	$1.21	$1.39	Yes	450 per 3 months
	Adult Diaper /Tabs, XXX Large	99401092	$1.43	$1.63	Yes	450 per 3 months
No Change	Liners, Disposable	99400438	$0.55	$0.63	Yes	450 per 3 months

Please note: no changes have been made to the items/codes below

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Delivery incontinence items	99400820	Yes
Diaper tabs, child over 2 years of age	99400752	Yes	450per 3 months
Diaper pull-up, child over 2 years of age	99400753	Yes	450 per 3 months
Diapers washable, child over 2 years of age	99400754	Yes	12 per year
Diapers washable, adult	99400441	Yes	12 per year
Liners, washable	99400439	Yes	12 per year
Pant, (brief) mesh, reusable	99400755	Yes	9 per 3 months
Underpads, disposable	99400442	Yes	150 per 3 months
Underpads, washable	99400443	Yes	1 per year

2.7 Wound Dressing Supplies

For a comprehensive list of wound care dressing and supplies and their corresponding benefit codes, please consult the Dressing List developed by the Non-Insured Health Benefits (NIHB) Program.

2.7.1 Adhesive Tapes and Dressing Strips

Table - Adhesive Tapes & Dressing Strips

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

2.7.2 Bandages

Table - Bandages

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

2.7.3 Dressings

Table - Dressings

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
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
Honey Dressings	99400901	Yes
Transparent film dressings, (adhesive)	99400464	Yes
Transparent film dressings, (spray-on)	99400465	Yes

2.7.4 Other Dressings

Table - Other Dressings

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

2.8 Low Vision Aids

Table - Low Vision Aids

Item Description	Item Code	Prior Approval	Recommended Replacement Guidelines
Coloured filters	99400873	Yes
Face cradle, rental	99400876	Yes
Illuminated magnifier - handle	99400870	Yes
Illuminated magnifier - head	99400869	Yes
Magnifier	99400868	Yes
Microscope	99400871	Yes
Telescope/monocular	99400872	Yes
White cane	99400874	Yes
White cane tips	99400875	Yes	3 per year