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First Nations & Inuit Health

Medical Supplies and Equipment Benefits

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2.0 General Benefits List

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

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 ESI Canada 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.

2.1 Bathing and Toileting Aids

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

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

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

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

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

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

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

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

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)

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)

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)

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

Mobility Aids: Miscellaneous
Item Description Item
Code
Prior Approval Recommended Replacement Guidelines
Delivery of equipment 99400819 Yes  
 

2.5 Ostomy Supplies and Devices

Ostomy Supplies and Devices (with Prices)
Item Description Item Code Price for Province Price for Territories Prior Approval Replacement Guidelines
One-piece urostomy pouch, flat 99400731 $13.30 $15.20 Yes 50 per 3 months
One-piece urostomy pouch, convex 99400732 $13.71 $15.67 Yes 50 per 3 months
Two-piece urostomy pouch 99400745 $6.39 $7.31 Yes 30 per 3 months
Flange - Flat 99400742 $9.28 $10.61 Yes 50 per 3 months
Flange - Convex 99400743 $13.08 $14.95 Yes 50 per 3 months
One-piece, Drainable, Flat, Colostomy/Ileostomy pouch 99400406 $8.03 $9.18 Yes 30 per 3 months
One-piece, Drainable, Convex, Colostomy/Ileostomy pouch 99400730 $11.90 $13.60 Yes 30 per 3 months
One-piece, Closed, Flat, Colostomy/Ileostomy pouch 99400905
(Formerly 99400729)
$4.80 $5.50 Yes 120 per 3 months
One-piece, Closed, Convex, Colostomy/Ileostomy pouch 99400906
(Formerly 99400729)
$7.01 $8.01 Yes 120 per 3 months
Two-piece, Closed, Colostomy/Ileostomy Pouch 99400414 $3.20 $3.65 Yes 120 per 3 months
Two-piece, Drainable, Colostomy/Ileostomy Pouch 99400415 $6.19 $7.07 Yes 30 per 3 months

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

Ostomy Supplies and 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
Convex inserts 99400401 Yes 30 per 3 months
Filters 99400402 Yes 2 boxes of 50 per year
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
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
 

2.6 Urinary Supplies and Equipment

2.6.1 Catheter Supplies and Equipment

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 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

Incontinence Supplies
Item Code Price for Province Price for Territories Prior Approval Replacement Guidelines
Adult Diapers/Pull-Ups, Small or Medium 99401087 $1.28 $1.46 Yes 450 per 3 months
Adult Diapers/Pulls, Large or Extra Large 99401088 $1.37 $1.57 Yes 450 per 3 months
Diapers/Pull-Ups, XXX Large 99401089 $1.56 $1.78 Yes 450 per 3 months
Adult Diaper/Tabs, Small or Medium 99401090 $1.02 $1.17 Yes 450 per 3 months
Adult Diaper/Tabs, Large or Extra Large 99401091 $1.25 $1.43 Yes 450 per 3 months
Adult Diaper/Tabs, XXX Large 99401092 $1.47 $1.68 Yes 450 per 3 months
Liners, Disposable 99400438 $0.57 $0.65 Yes 450 per 3 months

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

Incontinence Supplies
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

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

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

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

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

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