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4.0 Medical Supplies and Equipment
Oxygen Supplies and Equipment
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(PDF Version - 57 K)Oxygen Supplies and Equipment
See the Oxygen Therapy Benefits and Criteria for a full list of eligible products, prior approval requirements and frequency limitations.
For information on policies regarding the provision of oxygen equipment and supplies, please consult the Provider Guide for Medical Supplies and Equipment.
Oxygen Supplies and Equipment
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.
4.1 Oxygen Systems and Equipment
| Item Description | Item Code | Prior Approval | Recommended Replacement Guidelines |
|---|---|---|---|
| Concentrator with back up cylinder, rental | 99400224 | Yes | |
| Concentrator, purchase | 99400473 | Yes | 5 years |
| Homefill, purchase | 99400828 | Yes | 5 years |
| Homefill, rental | 99400829 | Yes | |
| Portable concentrator, purchase, 1 battery | 99400862 | Yes | 5 years |
| Portable concentrator, rental, 1 battery | 99400863 | Yes |
Oxygen cylinder with content, regulator, holder, cart, shoulder pouch c/s straps
Additional oxygen cylinder without content, regulator, holder, cart, shoulder pouch
4.2 Oxygen Supplies
| Item Description | Item Code |
Prior Approval | Recommended Replacement Guidelines |
|---|---|---|---|
| Distilled water | 99400626 | No | 4L containers/55 per year |
| Replacement battery, portable concentrator | 99400864 | Yes | 2 per year |
Disposables (Plastics)*
| Item Description | Item Code |
Prior Approval | Recommended Replacement Guidelines |
|---|---|---|---|
| Extension oxygen tubing 25 ft * | 99400234 | Yes | 4 per year |
| Extension oxygen tubing 50 ft * | 99400214 | Yes | 4 per year |
| E-Z Wrap * | 99400235 | Yes | 24 per year |
| Filters for concentrator * | 99400220 | No | 12 per year |
| Humidifier (bubble) * | 99400237 | No | 6 per year |
| Masks * | 99400238 | No | 24 per year |
| Masks (tracheostomy) * | 99400627 | No | 24 per year |
| Nasal Cannula * | 99400239 | No | 24 per year |
| Oxygen connectors/ adaptors * | 99400207 | No | |
| Water Traps * | 99400545 | No | 2 per year |
* If the oxygen system is rented the disposables are automatically included in the price of the rental. If the oxygen system is purchased the disposables may be billed only if they are not included in the maintenance agreement for oxygen system.
Gas content only (for cylinders)
