5.0 Oxygen equipment and supplies benefits list

Effective date: February 26, 2024

The following Medical Supplies and Equipment (MS&E) list contains oxygen items and services eligible under the Non-Insured Health Benefits (NIHB) program for eligible First Nations and Inuit. Further you’ll find information on coverage policies, item codes, requirements for prior approval and applicable recommended replacement guidelines.

Table of contents

5.1 General information

5.1.1 Benefit policies

General information common to all medical supplies and equipment (MS&E) can be found in the general policies.

5.1.1.1 General information

  • home oxygen may be considered for coverage by the NIHB program once the client's condition is stabilized and treatment regimen is optimized
  • coverage is authorized for the primary residence only, except for additional oxygen requirements due to travel to attend a medical appointment
  • while supplemental oxygen to attend medical appointments is assessed on a case-by-case basis, it is expected that the client will use the oxygen concentrator when possible
  • NIHB covers oxygen portability away from the primary residence to complete essential activities in the client's home and community, for example, shopping for groceries or personal items (up to 12 cylinders per month)
  • with medical justification, NIHB will consider additional portability (above 12 cylinders per month) on a case-by-case basis
  • NIHB expects that the provider will optimize the client's oxygen supply with the use of an oxygen conserving devices (OCD) (such as an OCD regulator for cylinders or the OCD moustache or pendant style nasal cannula)

5.1.2 Prescriber and provider requirements

Prescriptions or recommendations for coverage must be initiated by the health professionals identified as prescribers or recommenders of supplemental oxygen therapy. Oxygen therapy prescribed by prescribers/recommenders not recognized by NIHB for the specific item will lead to denials or reversal of claims.

The following is a list of NIHB-recognized prescriber/recommender abbreviations found in this segment of the benefits list. Please refer to the prescriber section of the item tables below to identify the eligible prescriber/recommender of a specific item:

  • MD — Physician
  • NP — Nurse Practitioner
  • PA — Physician Assistant - (applies to Manitoba only)

The following is a list of NIHB-recognized provider abbreviations found in this segment of the benefits list. Please refer to the provider section of the item tables below to identify the eligible provider of a specific item:

  • GEN — Enrolled general medical supplies and equipment or pharmacy provider
  • OP — Oxygen Provider with at least one of the required health care professionals on staff:
    • LPN/RPN — Licensed Practical Nurse/Registered Practical Nurse when within their scope of practice in their province/territory
    • RN — Registered Nurse
    • RRT — Registered Respiratory Therapist

Please note: once the oxygen therapy is prescribed, the oxygen provider with at least one of the required health care professionals on staff (for example, RRT, RN or LPN/RPN) can select the oxygen equipment and supplies that will meet the client’s medical needs.

5.1.3 Prior approval requirements

General prior approval requirements can be found in the general policies.

To start the prior approval process, the Oxygen Prior Approval Form, found on the Express Scripts Canada NIHB provider and client website, must be completed in full and submitted to your NIHB regional office along with the following documentation:

  • a prescription detailing the oxygen flow (in litres per minute or pulse dose) signed and dated by an NIHB-recognized prescriber
    • a titration prescription can be accepted if the provider includes the determined flow rate in litres per minute or the pulse dose
    • the quantity of oxygen used (hours per day) must be submitted when oxygen is needed for exercise or sleep to determine cylinder portability, and may be requested to confirm eligibility
  • diagnosis and medical indication
  • testing information as listed in section 5.2 Oxygen equipment and devices, including arterial blood gas (ABG) results or 5-minute oximetry strips
  • make, model and detailed cost breakdown of requested items
  • any additional documentation to support the request
  • an explanation of benefits from any third-party coverage available to the client (for example, provincial plan, workers' compensation board, private insurance, education plan, etc.)
  • note: for a change in funded equipment or quantity, a written explanation from an RRT, RN or LPN/RPN is accepted

Requests for oxygen coverage must be submitted within 1 month after testing.

5.1.3.1 Rental coverage periods

There are 3 consecutive coverage periods for oxygen that applies to all medical indications*. Requests should follow this order:

  1. Initial request is for 3 months (or 6 months for palliative care clients)
  2. First renewal request is for 9 months
  3. All other renewal requests are for 12 months (annual basis)

The prior approval request must indicate the coverage period requested including the start and end dates.

When oxygen therapy is no longer required, please refer to section 5.1.9 End of supplemental oxygen therapy.

* This rental sequence does not apply to nocturnal desaturation in adults with sleep-disordered breathing. For this condition, the initial coverage period is 3 months and all renewals are for 12 months.

5.1.4 Exclusions

In addition to the general exclusion policy listed in the general policies, the following items are excluded from the oxygen benefit and are not considered for coverage or appeal under the NIHB program:

  • oxygen for therapy treatment and/or therapy equipment, including but not limited to:
    • pain relief (for example, migraines, cluster headaches, chronic fatigue syndrome)
    • topical or systemic hyperbaric treatment
    • oxygen for angina in the absence of documented chronic hypoxemia
  • oxygen benefits for outings while the client is an in-patient in an acute or long-term hospital setting
  • oxygen to run nebulizers/compressors
  • oxygen on a "stand-by basis" (PRN)
  • room air humidifiers

5.1.5 Warranties

Providers must honour the manufacturer's warranty.

5.1.6 Repairs

All warranty coverage must be exhausted before requests for the payment of repairs are submitted to the NIHB program.

Repairs for purchased equipment that are not covered under the warranty are eligible for coverage when supported by proper documentation.

The following rules apply:

  • prior approval is required for repairs
  • request must include a description of all repairs with dates, a detailed cost breakdown of parts, labour time and rates
  • repairs must have a minimum warranty of 90 days

Note: The NIHB program will not cover the labour cost for repairs that are covered under the warranty.

The NIHB program will not cover the cost to repair rented equipment.

5.1.7 Replacement requirements

Recommended replacement guidelines indicate the quantity and frequency at which an item may be eligible for coverage. Recommended replacement guidelines are based on a client's customary medical need and the typical device's lifespan.

Replacement is subject to the same process as the original purchase or rental.

All requests to replace purchased equipment or to renew the rental of oxygen equipment requires new testing and assessment results. A new prescription is required if the previous prescription has expired, if there is a change in the client’s condition or if requested by the program.

Replacement of oxygen supplies does not require a new prescription. The existing prescription on file for oxygen therapy can be used for the oxygen supplies (note: the prescription does not need to list the required supplies). This prescription is valid for the lifespan of the purchased equipment or the length of the rental period.

For more general information please see section 1.12 Recommended replacement guidelines.

5.1.7.1 Early replacement requirements

Coverage requests for any early replacement requires prior approval and a new prescription or a written justification from an RRT, RN or RPN/LPN supporting the need for early replacement. The client must meet program and equipment-specific eligibility criteria.

Early replacement of items may be considered when one of the following has occurred:

  • there is a substantial change in a client's medical condition (for example, substantial change in SpO2 levels, ejection fraction, pulmonary function, etc.) or activity levels, and the current item no longer meets the client's needs
  • the item is no longer working properly, has deteriorated during normal use and is no longer under warranty (where the cost of repair is higher than the cost of a new item)

The program will not cover the replacement of lost items, stolen items, or items that are damaged due to misuse or negligence.

5.1.8 Services included in the price

The following services must be included in the price of the item to be considered for coverage:

  • complete set-up within 24 hours of authorization (except for ferry and remote site transportation limitations)
  • equipment delivery, safety and care, and client education on the use
  • a respiratory therapist or nurse visit within 72 hours, after 3 months, and every 6 months thereafter to ensure optimum oxygen therapy (for example, review prescription, review the use of equipment, educate the client on condition)
  • initial and follow-up assessments
  • rental equipment must be removed as soon as feasible after being informed that it is no longer required

5.1.9 End of Supplemental Oxygen Therapy

When oxygen equipment is no longer required, the following rules apply:

  • a prescription to stop oxygen therapy is required unless the client:
    • is deceased
    • made an informed decision to stop oxygen therapy
  • provider should retain a copy of the prescription or documentation of the client's decision for their records
  • providers must inform the program (by call or fax) when supplemental oxygen is no longer required and submit the benefit end date
  • claims submitted after the provider has been made aware that the client no longer requires the use of oxygen therapy and equipment are subject to recovery or reversal

5.1.10 Terminology

Item code

The item code is an 8-digit code that identifies the benefit being requested and is submitted to Express Scripts Canada for billing purposes.

Prior approval

A program coverage confirmation is issued by an NIHB regional office to a provider to ensure that the client is eligible for specific medical supplies and equipment benefits. The approval is issued primarily for items identified as requiring prior approval before being billed to the program. All claims, including claims accompanied by prior approvals, are subject to claim verification.

Recommended replacement guidelines

The recommended replacement guidelines set a maximum number of each item a client may receive over a given period (frequency). Coverage of additional items may be considered on a case-by-case basis. For requests exceeding the recommended replacement guidelines, prior approval is required.

Price guidance

Price guidance may be found in the price files, located on the Express Scripts Canada NIHB provider and client website. Providers are required to justify their costs and submit for reimbursement according to the NIHB claims submission kit.

5.2 Oxygen equipment and devices

5.2.1 Testing information

  • new testing results and a new assessment are required for each coverage period. The same results and assessment cannot be used for 2 different coverage periods
    • the testing and assessment can be performed in a clinical setting or at the client’s residence by one of the following health professionals: MD, NP, RRT, RN or RPN/LPN
  • testing and assessment should be performed and dated within 1 month of the start of the coverage period to provide up-to-date information on a client’s respiratory condition
  • results and assessments that are older than 1 month from the start of the coverage period may not be accepted
  • requests for oxygen coverage should be submitted within 1 month after testing was performed
  • please refer to the appropriate medical indication for a list of the specific testing information that must be submitted

Arterial blood gas (ABG) and its requirements:

  • ABGs must be completed at rest on room air
  • an ABG result obtained during an acute exacerbation is not accepted
  • please note: although an ABG result is not required, it may be requested to confirm eligibility

Capillary blood gas (CBG) and its requirements:

  • may be submitted for funding consideration for neonatal and pediatric clients

Oximetry testing and its requirements:

  • the oximetry test is performed both on room air and on supplemental oxygen while at rest and when applicable during exertion. This test should confirm that a client's medical condition improves when supplemental oxygen is administered
  • the test results must be legible and include the:
    • date of testing
    • client name
    • health professional’s name and qualifications
    • oxygen flow rate or pulse dose
    • heart rate/pulse
    • distance walked (when applicable)
    • level of shortness of breath using the Borg Scale (when applicable)
    • oxygen saturation (SpO2%)
      • each printout or manually completed form must record at least 5 continuous minutes of monitoring if the client can tolerate it
      • if the saturation is less than 89% for 2 continuous minutes within a 5-minute period of continuous monitoring on room air, then no further room air testing is required (proceed to testing with supplemental oxygen)
  • in situations where testing cannot be completed, an explanation must be provided
  • the Oximetry Instructions and Form, found on the Express Scripts Canada NIHB provider and client website, is an optional tool for providers

Oxygen equipment requirements (for oximetry testing):

  • oximetry testing should be performed with the requested oxygen equipment (for example, with a portable oxygen concentrator)
  • testing results with the requested equipment must be submitted, with the exception of oxygen conserving devices (OCD) where the following applies:
    • providers are not required to submit the oximetry testing results using an OCD regulator to support that the client can trigger the device
    • oximetry test results must be kept in the client file and submitted if requested for verification purposes
    • when the client is unable to activate the OCD regulator, providers are required to inform the regional office to update the prior approval

5.2.2 Medical indications

  • adult resting hypoxemia
  • adult exertional hypoxemia
  • adult nocturnal desaturation
  • cardiac conditions
  • palliative care
  • pediatric hypoxemia

5.2.3 Adult resting hypoxemia

Documentation required Testing criteria
(client must meet ONE)
  • prior approval form including items listed in section 5.1.3 Prior approval requirements
  • arterial blood gas (ABG) or 5-minute oximetry strip at rest on room air as in section 5.2.1 Testing information
  • assessment by an RRT/RN/RPN/LPN must be submitted if available for the initial 3-month period. Assessment is required for renewal requests
  • a PaO2 of 55 mmHg or less
  • a PaO2 between 56 and 59 mmHg with hypoxemia on exertion (SpO2 less than 89% for 2 continuous minutes)*
  • a PaO2 of 60 mmHg or less with evidence of cor pulmonale, pulmonary hypertension and/or secondary polycythemia
    OR
  • oximetry at rest that demonstrates sustained desaturation (SpO2 less than 89% for 2 continuous minutes)
* Clients with an ABG result between 56 and 59 mmHg must demonstrate hypoxemia on exertion. Please refer to the testing criteria listed in section 5.2.4 Adult exertional hypoxemia.

5.2.4 Adult exertional hypoxemia

Documentation required Testing criteria
(client must meet A, B* & C)
  • prior approval form including items listed in section 5.1.3 Prior approval requirements
  • arterial blood gas (ABG) or 5-minute oximetry strip at rest as detailed in section 5.2.1 Testing information
  • oximetry on exertion with:
    • Borg Scale
    • distance walked
    • time travelled
  • assessment by an RRT/RN/RPN/LPN must be submitted if available for the initial 3-month period. Assessment is required for renewal requests
  1. Room air testing at rest (oximetry or ABG):
    • SpO2 greater than 90%
      OR
    • PaO2 greater than 60 mmHg (for example, demonstrating non-hypoxemia at rest)
  2. Exercise testing on room air (oximetry):
    • sustained desaturation (SpO2 less than 89% for 2 continuous minutes)
  3. Exercise testing with supplemental oxygen (oximetry):
    • testing must be performed with the requested equipment
    • improved breathlessness (BORG scale decrease of at least one unit at the end of the exercise)
    • improved exercise capacity (improved walking distance by at least 25% and at least 30 meters OR time travelled increased by at least 25% and at least 2 minutes)

* If exercise testing on room air demonstrates a SpO2 level less than 80% with good pulse tracking regardless of dyspnea or distance walked, the applicant meets eligibility criteria and no further testing is required for the requested funding period.

Note: Exercise testing should be completed while the client performs their primary means of mobility (for example, walking, wheelchair propulsion, transfers, etc.). Any type of safe seated or standing exercise that meets the client’s conditioning level and that increases their heart rate (for example, exercise bands or weights, arm raises, stationary bicycle, arm bicycle, elliptical, etc.) will also be accepted.

5.2.5 Adult nocturnal desaturation

5.2.5.1 Nocturnal desaturation – without sleep-disordered breathing

Documentation required Testing criteria
(client must meet A & B)
  • prior approval form including items listed in section 5.1.3 Prior approval requirements
  • overnight oximetry strips as detailed in section 5.2.1 Testing information
  • assessment by an RRT/RN/RPN/LPN must be submitted if available for the initial 3-month period. Assessment is required for renewal requests
  1. room air testing demonstrating nocturnal desaturation less than 89% for 30% of the night
  2. sleep-disordered breathing must be ruled out

5.2.5.2 Nocturnal desaturation – with sleep-disordered breathing

NIHB’s nocturnal desaturation for adults with sleep-disordered breathing initial coverage period is for up to 3 months. Following renewal requests will be considered for a period of 12 months with different requirements from the initial coverage period.

5.2.5.2.1 Initial request (3 months)
Documentation required Testing criteria
(client must meet A, B & C)
  • prior approval form including items listed in section 5.1.3 Prior approval requirements
  • diagnostic sleep study with interpretation by a physician with expertise in sleep medicine. Accepted sleep studies:
    • level I
    • level III (home sleep study)
    • level IV (overnight oximetry)
  • assessment by an RRT/RN/RPN/LPN must be submitted if available for the initial 3-month period
  1. Diagnosis of sleep disordered breathing
  2. Persistent hypoxemia demonstrating nocturnal desaturation less than 89% for 30% of the night that is not corrected with positive airway pressure (PAP)* therapy
  3. Level I, III, or IV sleep study with interpretation by a physician with expertise in sleep medicine that demonstrates improvement when using oxygen with a positive airway pressure (PAP) device
* Special consideration will be given to clients with sleep-disordered breathing who are unable to tolerate PAP therapy when accompanied by a written justification supporting the need.
5.2.5.2.2 Renewal request (12 months)
Documentation required Testing criteria
(client must meet A & B)
  1. A prescription that includes the PAP pressure settings and oxygen flow rate
  2. Download that includes the clients overnight apnea-hypopnea index (AHI) and nocturnal saturations levels

Note: a new sleep study is not required for renewals.
* Special consideration will be given to clients with sleep-disordered breathing who are unable to tolerate PAP therapy when accompanied by a written justification supporting the need.

5.2.6 Cardiac conditions

Documentation required Testing criteria
(client must meet A & B)
  • prior approval form including items listed in section 5.1.3 Prior approval requirements
  • 5-minute oximetry strip at rest on room air only as detailed in section 5.2.1 Testing information
  • documentation provided by a physician to support New York Heart Association Stage IV Heart Disease (only required for initial 3 months)
  • assessment by an RRT/RN/RPN/LPN must be submitted if available for the initial 3-month period. Assessment is required for renewal requests
  1. New York Heart Association Stage IV Heart Disease* (Severe)
  2. oximetry that demonstrates sustained desaturation (SpO2 less than 89% for 2 continuous minutes)
* Defined as symptoms of Congestive Heart Failure (CHF) occur at rest (severe CHF). Any physical activity increases discomfort and symptoms. Client may be symptomatic at less than ordinary levels of activity.

5.2.7 Pediatric - for children (18 years of age or less)

Documentation required Testing criteria
(client must meet ONE)
  • oximetry that demonstrates sustained desaturation (SpO2 less than 93%)
  • oximetry that demonstrates nocturnal oxygen desaturation (SpO2 less than 92% for 12% of the night)
  • supplemental oxygen may be considered with a letter from the prescribing physician outlining the evidence for supplemental oxygen if the above criteria have not been met
* Special consideration will be given to children who are unable to tolerate room air testing.

5.2.8 Palliative care

The client must have been diagnosed with a terminal illness or disease which is expected to be the primary cause of death within 6 months or less.

NIHB's palliative care home initial oxygen coverage period is for up to 6 months of palliative oxygen. Following renewal requests will be considered for a period of 9 months and then 12 months with the same testing requirements as the initial coverage period.

Documentation required Testing criteria
(Client must meet ONE)
  • PaO2 of 60 mm Hg or less
  • oximetry that demonstrates sustained desaturation (SpO2 less than 92% for 2 continuous minutes)
    OR
  • supplemental oxygen may be considered with a letter from the prescribing physician, nurse practitioner or palliative care team member (for example, registered nurse) outlining the evidence for supplemental oxygen (for example, dyspnea that cannot be improved with medication or comfort analgesia)

5.2.9 Cylinder rental

The different elements needed to rent an oxygen cylinder each have their own item code:

  • the gas or liquid oxygen content
  • the system which includes
    • a regulator
    • a carrying device (for example, cart or cylinder bag) that is appropriate and safe for the client’s usual mode of mobility
  • the cylinder (empty container)

As part of the monthly rental fees, providers should request the combination of item codes needed.

If the oxygen system is rented, the disposables are automatically included in the price of the rental.

5.2.9.1 Oxygen content

The following items codes refer only to the gas or liquid oxygen content and must correspond to the cylinder size.

Item code Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400221 Cylinder D/M9 (356 L), oxygen content MD, NP, PA OP Yes 12 per month  
99400226 Cylinder E (622 L), oxygen content MD, NP, PA OP Yes  
99400229 Cylinder S/M (5260 L), oxygen content MD, NP, PA OP Yes  
99400230 Cylinder H/K (6900 L), oxygen content MD, NP, PA OP Yes  
99400233 Liquid oxygen (in kg), content MD, NP, PA OP Yes    
* Registered Respiratory Therapists (RRT) can select and recommend oxygen benefits once the oxygen therapy and flow rate have been prescribed in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick and Newfoundland and Labrador.

5.2.9.2 Oxygen system

The oxygen system item code must correspond to the rented cylinder size and includes the following components:

  • standard regulator
  • 2-wheeled cylinder cart
  • cylinder bag with one or more handles and/or straps

The standard regulator may be replaced by the oxygen conserving device regulator or the low flow oxygen meter listed in section 5.3 Supplies.

For clients who require an oxygen holder that is mounted to a mobility device (for example, wheelchair, walker), please refer to 11.0 Mobility equipment and supplies benefits list.

Item code Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400227 Cylinder D/M9 (356 L), system rental MD, NP, PA OP Yes 12 per month  
99400228 Cylinder E (622 L), system rental MD, NP, PA OP Yes  
99400231 Cylinder S/M (5260 L), system rental MD, NP, PA OP Yes  
99400232 Cylinder H/K (6900 L), system rental MD, NP, PA OP Yes  
99400544 Oxygen conserving device, regulator, rental MD, NP, PA OP Yes  

This device replaces the standard regulator

This item cannot be used with the moustache/pendant oxygen conserving device (99401424)
99400225 Liquid O2, portable, system rental MD, NP, PA OP Yes  

Includes:

  • the portable (cannister) unit
  • system rental (regulator, cart, carrying bag with handle or strap)
* Registered Respiratory Therapists (RRT) can select and recommend oxygen benefits once the oxygen therapy and flow rate have been prescribed in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick and Newfoundland and Labrador.

5.2.9.3 Oxygen cylinder

The following item codes refer only to the empty cylinder container used to contain the oxygen gas. The size of the cylinder must meet the client’s oxygen flow needs (continuous vs. pulsed), portability requirements and ambulation requirements (ability to safely carry).

NIHB covers up to 12 cylinders per month for portability away from the primary residence to complete essential activities in the client’s home and community. Requests above 12 cylinders per month requires medical justification and will be reviewed on a case-by-case basis. Additional information may be requested to support review.

Item number Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400631 Cylinder D/M9 (356 L), rental MD, NP, PA OP Yes 12 cylinders per month  
99400632 Cylinder E (622 L), rental MD, NP, PA OP Yes  
99400633 Cylinder S/M (5260 L), rental MD, NP, PA OP Yes  
99400634 Cylinder H/K (6900 L), rental MD, NP, PA OP Yes  
* Registered Respiratory Therapists (RRT) can select and recommend oxygen benefits once the oxygen therapy and flow rate have been prescribed in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick and Newfoundland and Labrador.

5.2.10 Concentrator purchase

If the oxygen system is purchased, the disposables may be billed only if they are not included in the maintenance agreement for the oxygen system.

Item code Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400473 Concentrator, purchase MD, NP, PA OP Yes 1 every 5 years  
99400828 Homefill, purchase MD, NP, PA OP Yes 1 every 5 years  
99400862 Portable concentrator +2 batteries, purchase MD, NP, PA OP Yes 1 every 5 years Portable oxygen concentrator (POC) includes 2 batteries (one that comes with the purchased device plus one extra interchangeable battery)
* Registered Respiratory Therapists (RRT) can select and recommend oxygen benefits once the oxygen therapy and flow rate have been prescribed in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick and Newfoundland and Labrador.

5.2.11 Concentrator rental

Item code Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400863 Concentrator portable (POC) + 2 batteries, rental MD, NP, PA OP Yes   Portable oxygen concentrator (POC) includes 2 batteries (one that comes with the rented device plus one extra interchangeable battery)
99400224 Concentrator stationary w/ backup cylinder, rental MD, NP, PA OP Yes    
99400636 Dual system with content, rental MD, NP, PA OP Yes    
99400635 Dual system without content, rental MD, NP, PA OP Yes    
99400829 Homefill, rental MD, NP, PA OP Yes    
* Registered Respiratory Therapists (RRT) can select and recommend oxygen benefits once the oxygen therapy and flow rate have been prescribed in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick and Newfoundland and Labrador.

5.3 Supplies

To be eligible for the coverage of oxygen supplies, the client must meet section 5.1.3 Prior approval requirements for supplemental oxygen therapy. The existing prescription for supplemental oxygen therapy can be used for the oxygen supplies (note: the prescription does not need to list the required supplies). This prescription is valid for the lifespan of the purchased equipment or the length of the rental period.

Note: supplies can be selected by an RRT, RN, or LPN/RPN (when within their scope of practice).

The term "disposables" refers to all oxygen supplies with the exception of the battery replacement for the portable oxygen concentrator, the distilled water (4L), the rental of the low flow oxygen meter, and the moustache/pendant style oxygen conserving device.

Item code Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400864 Battery replacement, portable oxygen concentrator MD, NP, PA OP Yes 2 per year For purchased POC only.

Year 1: not eligible for coverage since the POC purchase includes 2 batteries.

Year 2 onwards: replacement is eligible annually once the battery warranty has expired.
99400220 Concentrator filter MD, NP, PA OP No 12 per year  
99400626 Distilled water (4L) MD, NP, PA GEN No 55 per year For use with the bubble humidifier (code 99400237).
99400235 Ear cushions for oxygen tubing MD, NP, PA OP No 24 pairs per year

Tubular foam pieces which wrap around tubing or straps to protect the integrity of the skin behind the ears and of the face. Can be used with:

  • nasal cannula
  • simple face mask
  • moustache/pendant oxygen conserving device
99400237 Humidifier (bubble) MD, NP, PA OP No 6 per year A reusable water container that is connected to an oxygen system (such as a concentrator) to provide humidified oxygen to the user.
99400244 Low flow oxygen meter, rental MD, NP, PA OP Yes    
99400238 Oxygen, simple face mask MD, NP, PA OP No 24 per year  
99400239 Nasal cannula MD, NP, PA OP No  
99401424 Oxygen conserving device, moustache/pendant MD, NP, PA OP Yes 24 per year This item cannot be used with the oxygen conserving device regulator (99400544)
99400207 Oxygen connector and adaptor MD, NP, PA OP No 6 per year  
99400234 Oxygen tubing, 25 ft. extension MD, NP, PA OP No 4 per year  
99400214 Oxygen tubing, 50 ft. extension MD, NP, PA OP No  
99400545 Water trap MD, NP, PA OP No 2 per year For clients using oxygen humidification.
* Registered Respiratory Therapists (RRT) can select and recommend oxygen benefits once the oxygen therapy and flow rate have been prescribed in provinces and territories where these activities are deemed within their scope of practice, and in accordance with appropriate legislation, regulations, acts or formal governance overseeing the practice. This includes Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia, New Brunswick and Newfoundland and Labrador.

5.4 Servicing

5.4.1 Repairs and maintenance

Item code Item name Prescriber* Provider Prior approval required Recommended replacement guidelines Additional details
99400638 Maintenance agreement, for purchased oxygen system   OP Yes   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.
99400243 Oxygen system, repairs   OP Yes    

5.4.2 Delivery

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400262 Delivery, oxygen   OP Yes    

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