36:00 Diagnostic Agents
36:00.00 DIAGNOSTIC AGENTS (DX)
COAGULATION MONITORS
Limited use benefit (prior approval required).
For monitoring the international normalized ratio (INR) in patients who require long-term oral anticoagulation.
- client has difficulty accessing laboratory-based INR testing.
Coverage is limited to 1 meter every 2 years.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Device | 97499983 | COAGUCHEK INRANGE METER | ROD |
Device | 97499986 | COAGUCHEK XS KIT | ROD |
COAGULATION TEST
Limited use benefit (prior approval required).
For monitoring the international normalized ratio (INR) in patients who require long-term oral anticoagulation.
- client has difficulty accessing laboratory-based INR testing.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Strip | 97499988 | COAGUCHEK XS PT STRIPS 24 | ROD |
Strip | 97499987 | COAGUCHEK XS PT STRIPS 48 | ROD |
Strip | 97499989 | COAGUCHEK XS PT STRIPS 6 | ROD |
LANCET
Limited use benefit (prior approval not required).
The number of lancets that will be covered by the NIHB Program will depend on the client's medical treatment:
- clients managing diabetes with insulin will be allowed 800 lancets per 100 days.
- clients managing diabetes with high risk of causing hypoglycemia will be allowed 400 lancets per 365 days.
- clients managing diabetes medication with low risk of causing hypoglycemia will be allowed 200 lancets per 365 days.
- clients managing diabetes through diet/lifestyle therapy only (no insulin or anti-diabetes medications) will be allowed 200 lancets per 365 days.
Please note that the test strip limit is 800/100 days. Due to lancet pack sizes, 800 per 100 days will be reimbursed.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Lancet | 97499991 | COAGUCHEK LANCETS | ROD |
36:26.00 DX - DIABETES MELLITUS
GLUCOSE OXIDASE, PEROXIDASE
Limited use benefit (prior approval not required).
The number of test strips that will be covered by the NIHB Program will depend on the client's medical treatment:
- clients managing diabetes with insulin will be allowed 800 test strips per 100 days. A client can test up to eight times per day.
- clients managing diabetes with diabetes medication with a high risk of causing low blood sugar will be allowed 400 test strips per 365 days. A client can test once daily.
- clients managing diabetes with diabetes medication with a low risk of causing low blood sugar will be allowed 200 test strips per 365 days. A client can test three to four times per week.
- clients managing diabetes with diet/lifestyle therapy only (no insulin or diabetes medications) will be allowed 200 test strips per 365 days. A client can test three to four times per week.
- non-diabetic clients with rare conditions leading to symptomatic hypo or hyperglycemia will be allowed 800 test strips per 100 days.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
ACCU-CHEK ADVANTAGE Strip | 09853626 | ACCU-CHEK ADVANTAGE | ROD |
ACCU-CHEK ADVANTAGE Strip | 97799824 | ACCU-CHEK ADVANTAGE | ROD |
ACCU-CHEK AVIVA Strip | 09857178 | ACCU-CHEK AVIVA | ROD |
ACCU-CHEK AVIVA Strip | 97799814 | ACCU-CHEK AVIVA | ROD |
ACCU-CHEK COMPACT Strip | 09854282 | ACCU-CHEK COMPACT | ROD |
ACCU-CHEK COMPACT Strip | 97799962 | ACCU-CHEK COMPACT | ROD |
ACCU-CHEK MOBILE Strip | 09857452 | ACCU-CHEK MOBILE BG | ROD |
ACCU-CHEK MOBILE Strip | 97799497 | ACCU-CHEK MOBILE CASSETT | ROD |
ACCUTREND Strip | 09853162 | ACCUTREND | ROD |
ACCUTREND Strip | 97799959 | ACCUTREND | ROD |
ASCENSIA BREEZE 2 Strip | 97799748 | ASCENSIA BREEZE 2 | BAY |
ASCENSIA BREEZE 2 Strip | 09857293 | BREEZE 2 BG (ON) | BAY |
ASCENSIA CONTOUR Strip | 97799702 | ASCENCIA CONTOUR | BAY |
ASCENSIA CONTOUR Strip | 09857127 | CONTOUR BG (ON) | BAY |
BG STAR Strip | 97799465 | BG STAR | SAC |
CONTOUR NEXT Strip | 97799459 | CONTOUR NEXT | BAY |
CONTOUR NEXT Strip | 09857453 | CONTOUR NEXT (ON) | BAY |
EZ HEALTH Strip | 09857357 | EZ HEALTH ORACLE | TRE |
EZ HEALTH Strip | 97799564 | EZ HEALTH ORACLE | TRE |
FREESTYLE LITE Strip | 97799597 | FREESTYLE LITE | ABB |
FREESTYLE LITE Strip | 09857297 | FREESTYLE LITE (ON) | ABB |
FREESTYLE PRECISION Strip | 97799346 | FREESTYLE PRECISION | ABB |
FREESTYLE PRECISION Strip | 09857502 | FREESTYLE PRECISION (ON) | ABB |
FREESTYLE Strip | 97799829 | FREESTYLE | ABB |
FREESTYLE Strip | 09857141 | FREESTYLE (ON) | ABB |
GE200 Strip | 97799373 | GE200 | AUC |
GE200 Strip | 09857525 | GE200 (ON) | AUC |
ITEST Strip | 09857348 | ITEST | AUC |
ITEST Strip | 97799692 | ITEST | AUC |
MEDI+SURE Strip | 97799403 | MEDI+SURE | MEC |
MEDI+SURE Strip | 09857432 | MEDI+SURE (ON) | MEC |
NOVA MAX Strip | 09857313 | NOVA MAX | NCA |
ONE TOUCH ULTRA Strip | 09854290 | ONE TOUCH ULTRA | JAJ |
ONE TOUCH ULTRA Strip | 97799985 | ONE TOUCH ULTRA | JAJ |
ONE TOUCH VERIO Strip | 97799475 | ONETOUCH VERIO | JAJ |
ONE TOUCH VERIO Strip | 09857392 | ONETOUCH VERIO (ON) | JAJ |
PRECISION XTRA Strip | 09854070 | PRECISION XTRA | ABB |
PRECISION XTRA Strip | 97799840 | PRECISION XTRA | AUC |
SIDEKICK Strip | 97799601 | SIDEKICK | HOD |
SPIRIT Strip | 97799291 | FIRST CANHEALTH SPIRIT | ARA |
SPIRIT Strip | 09857547 | SPIRIT TEST STRIP (ON) | ARA |
Strip | 09857563 | ACCU-CHEK GUIDE (ON) | ROD |
Strip | 97799177 | ACCU-CHEK GUIDE (SK) | ROD |
SURE STEP Strip | 97799355 | SURE STEP | SKY |
SURETEST Strip | 09857522 | SURETEST (ON) | SKY |
TRUETEST Strip | 97799532 | TRUETEST | HOD |
TRUETRACK Strip | 09857283 | TRUE TRACK | AUC |
TRUETRACK Strip | 97799602 | TRUE TRACK | HOD |
36:60.00 DX - THYROID FUNCTION
THYROTROPIN ALFA
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
0.9MG/ML Powder For Solution | 02246016 | THYROGEN | GEE |
36:88.00 DX - URINE AND FECES CONTENTS
URINE TEST STRIP
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Strip | 97799914 | DIASTIX | BAY |
Strip | 97799913 | KETOSTIX | BAY |