10.0 Low vision equipment and supplies benefits list

Effective date: February 26, 2024

The following Medical Supplies and Equipment (MS&E) list contains low vision 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

10.1 General information

10.1.1 Benefit policies

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

10.1.2 Prescriber and provider requirements

Prescriptions or recommendations for coverage must be initiated by the health professionals identified as prescribers or recommenders of the item under the NIHB program. Items that are prescribed by prescribers/recommenders not recognized by NIHB 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:

  • LVS/CLVT — Low Vision Specialist/Certified Low Vision Therapist
  • MD — Physician
  • NP — Nurse Practitioner
  • O.D. — Doctor of optometry (optometrist)
  • OMT — Certified Ophthalmic Technician/Medical Technologist working under Stanton Territorial Health Authority in NWT and Nunavut
  • OT — Occupational Therapist
  • RN — Registered Nurse
  • CVRT — Certified Vision Rehabilitation Therapist
  • COMS — Certified Orientation & Mobility Specialist
  • ATS — Assistive Technology Specialist

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

10.1.3 Prior approval requirements

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

10.1.3.1 Low vision equipment and supplies:

To initiate the prior approval process, the Low Vision 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 supporting documentation:

  • eye assessment from an optometrist or ophthalmologist to determine the type of benefit required (covered under the Vision Care benefit)
  • prescription from an eligible NIHB prescriber for the requested benefit
    • when an eye assessment includes a prescription for items that can be prescribed by an optometrist or ophthalmologist, a separate prescription is not required
  • diagnosis
  • low vision functional assessment report (if available)
  • item recommended (make, model and MSRP)
  • additional relevant information the prescriber may have 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.)

Please note: a prescription that meets the program's prescription requirements for low vision equipment can be used to request the required supplies associated with that equipment. The prescription does not need to list the required supplies.

10.1.3.2 Low vision services:

Functional assessments

The purpose of functional assessments is to assess a person's current functional status given their visual impairment, to identify any areas where they may require support or assistance, to develop a plan to help them achieve their goals and to determine which visual aids and type of training are needed to maximize the client's independence. NIHB benefits includes coverage for four functional assessments: low vision aids, independent living aids, orientation and mobility aids, and assistive technology assessments.

To initiate the prior approval process, the Low Vision 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 supporting documentation:

  1. For Low Vision Aids, Independent Living Aids, Orientation and Mobility Aids functional assessments:
    • eye assessment from an optometrist or ophthalmologist indicating that the client has a visual acuity of 20/70 or lower (for example, 20/90),
      OR,
      the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
    • prescription from an eligible NIHB prescriber
      • when an eye assessment includes a prescription for items that can be prescribed by an optometrist or ophthalmologist, a separate prescription is not required
    • diagnosis (that is, low vision impairment)
    • additional relevant information the prescriber may have to support the request
  2. For Assistive Technology functional assessment:
    • eye assessment from an optometrist or ophthalmologist indicating that the client has a visual acuity of 20/200 or lower (for example, 20/220),
      OR,
      the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
    • prescription from an eligible NIHB prescriber
      • when an eye assessment includes a prescription for items that can be prescribed by an optometrist or ophthalmologist, a separate prescription is not required
    • diagnosis (low vision impairment)
    • additional relevant information the prescriber may have to support the request

Please note: a functional assessment is required when requesting a training program.

The functional assessment report should include the following:

  • Assessment of Ocular health
  • Diagnosis
  • Visual acuity
  • Device/s trialed
  • Summary of evaluation
  • Recommendations (for example, equipment recommended, training program, etc.)
Training programs

Step #1:

Client receives a low vision functional assessment performed by an NIHB eligible prescriber and obtains an assessment report.

If the client has already undergone a low vision functional assessment prior to submitting a request for a training program, skip step #1.

Step #2:

The following documentation must be submitted to your NIHB regional office:

  • A low vision functional assessment report. The functional assessment report must:
    • correspond to the requested training program (for example, for orientation and mobility aids training, an orientation and mobility aids functional assessment report is required)
    • be completed by an eligible NIHB prescriber
    • include the equipment being recommended
    • state that training is required for the client to be able to use the equipment
    • include the duration of the training program and itemize the number of hours of training required per equipment
  • An eye assessment from an ophthalmologist or optometrist, if available (covered under the Vision Care benefit)

Note: the low vision functional assessment is a NIHB benefit. See functional assessment found above in this section (10.1.3.2) for submission requirements.

10.1.4 Exclusions

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

  • computer and printer
  • cell phone
  • regular watch
  • wi-fi service and data plan
  • internet coverage
  • landline telephone service
  • eye assessment (covered under the Vision care benefit)

10.1.5 Warranties

Providers must honour the manufacturer's warranty.

10.1.6 Repairs

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

The following rules apply:

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

A description of all repairs with dates, detailed cost breakdown of parts, labour time and rates must be kept on file for each client.

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

10.1.7 Replacement requirements

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

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

An original prescription may be used for initial and replacement requests of low vision equipment and supplies when ALL of the following criteria are met:

  • the equipment/supply was initially covered by the NIHB program
  • the client's functional status remains the same
  • the item is eligible for replacement as per its recommended replacement guidelines

A copy of the prescription must be kept in the client's file at the provider's office for all replacements.

All other requests for replacement require a new prescription.

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

10.1.7.1 Early replacement requirements

Coverage requests for an early replacement requires prior approval and a new prescription or written justification from an eligible NIHB prescriber to support 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 vision status, etc.) and the item no longer meets the client's needs
  • the item is no longer functioning properly, has deteriorated during typical use and is no longer under warranty (where the cost of repair exceeds 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.

10.1.8 Services included in the price for equipment and supplies

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

  • product and parts ordering and delivery from manufacturer to provider (including delivery costs, exchange rate)
  • dispensing of the benefit, which includes any required adjustments or fittings
  • setup and installation

10.1.9 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.

10.2 Low vision aids

10.2.1 Eligibility criteria

  • visual acuity in both eyes with proper refractive lenses is 20/70 or less (for example, 20/90) with the Snellen Chart or equivalent,
    OR
    the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)

10.2.2 Magnifier

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400868 Optical magnifiers LVS/CLVT, , MD, RN, O.D., OMT, OT, NP GEN No 1 every 2 years  
99401390 Handheld digital magnifier LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 2 years For example, the Magno Digital Portable Magnifier, the Explore Kit, the Ruby 10 HD magnifier, etc.
99400869 Magnifier, illuminated head LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 2 years  
99400870 Magnifier, illuminated handle LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 2 years  
99400871 Microscope LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 3 years  
99400872 Telescope or monocular LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 3 years  
99401389 Loupe LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN No 1 every 3 years  

10.3 Orientation and mobility aids

10.3.1 Eligibility criteria

  • visual acuity in both eyes with proper refractive lenses is 20/70 or less (for example, 20/90) with the Snellen Chart or equivalent,
    OR
    the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)

10.3.2 Orientation and mobility

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401408 GPS technology LVS/CLVT, O.D., OMT, COMS GEN Yes 1 every 5 years For example, talking GPS such as the Stellar Trek
99400874 White cane LVS/CLVT, MD, O.D., OMT, COMS, NP, RN GEN Yes 1 per year  
99400875 White cane tip LVS/CLVT, MD, O.D., OMT, COMS, RN, NP GEN Yes 3 per year  

10.4 Assistive technology aids

10.4.1 Eligibility criteria

  • visual acuity in both eyes with proper refractive lenses is 20/200 or less (for example, 20/220) with the Snellen Chart or equivalent,
    OR
    the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)

10.4.2 Assistive technology

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401392 Desktop technology ATS, LVS/CLVT GEN Yes 1 every 5 years Includes CCTV (for example, Vario digital magnifier, Reveal 16 magnifier)
99401393 Software ATS, LVS/CLVT GEN Yes 1 every 2 years For example, Text to Speech, JAWS software ("Job Access With Speech"), Zoomtext Magnifier, etc.

The software (original license) and the software maintenance agreement (SMA) can be requested initially. After two years the SMA can be covered once again
99401394 Optical character recognition (OCR) ATS, LVS/CLVT, GEN Yes 1 every 4 years For example, ClearReader, LyriQ Reader
99401395 Brailler CVRT, ATS, LVS/CLVT GEN Yes 1 every 5 years Includes manual braillers (for example, the Perkins Brailler), as well as electronic braille display devices (for example, the Mantis Braille Display, the Notetaker, the Braillenote Touch, etc.)

10.5 Independent living aids

10.5.1 Eligibility criteria

  • visual acuity in both eyes with proper refractive lenses is 20/70 or less (for example, 20/90) with the Snellen Chart or equivalent,
    OR
    the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)

10.5.2 Independent living

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401401 Accessible phone CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 5 years Non-cellular phones, for example, the Geemarc AmpliCL phone, the Panasonic cordless phone, the Ameriphone, etc.
99401402 Recording device CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 5 years For example, Sony ICD recorder
99401403 Digital audio player CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 5 years Audio book player
99401404 Watch CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 3 years Includes braille tactile watch and talking low vision watch, for example, Ladies/Men Talk Date Time watch
99401405 Clock CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 5 years Talking low vision clock, for example, Talking Clock with Alarm and Date, talking Calendar Clock White Button, etc.
99401406 Talking blood pressure monitor CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 5 years  
99401407 Talking thermometer CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 1 every 5 years  
99401396 Braille paper CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN No 1 every 3 years 1 packet of 250 braille sheets
99401397 Braille labeller CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN No 1 every 5 years For example, the Braille Labeller (plastic), the Penfriend
99401398 Braille labeller tape CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN No 1 per year For example, Dymo clear tape

10.6 Supplies

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401419 Accessories CVRT, LVS/CLVT, MD, RN, O.D., OMT, OT, NP, COMS, ATS GEN Yes 1 claim every 2 years For example, headphones, charging bank, stand, carrying case, etc.

10.7 Services

10.7.1 Eligibility criteria for functional assessments

  1. For low vision aids, independent living aids, orientation and mobility aids functional assessments
    • visual acuity in both eyes with proper refractive lenses is 20/70 or less (for example, 20/90) with the Snellen Chart or equivalent,
      OR
      the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)
  2. For assistive technology functional assessment
    • visual acuity in both eyes with proper refractive lenses is 20/200 or less (for example, 20/220) with the Snellen Chart or equivalent
      OR
      the field of vision is severely restricted (for example, a visual field of 20 degrees or narrower)

10.7.2 Functional assessments

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401411 Functional assessment (FA) – Low vision aids LVS/CLVT, GEN Yes 1 assessment every 2 years $150/hr for a maximum of 2 hours
99401410 Functional assessment (FA)– Orientation and mobility aids LVS/CLVT, COMS GEN Yes 1 assessment every 2 years $150/hr for a maximum of 2 hours
99401412 Functional assessment (FA) -Assistive technology aids LVS/CLVT, CVRT, ATS GEN Yes 1 assessment every 2 years $150/hr for a maximum of 2 hours
99401413 Functional assessment (FA) – Independent living aids LVS/CLVT, CVRT GEN Yes 1 assessment every 2 years $150/hr for a maximum of 2 hours

10.7.3 Eligibility criteria for training programs

  • client must have a low vision functional assessment report. The functional assessment must be performed by an NIHB-eligible prescriber
  • the report must indicate which equipment is being prescribed for the client
  • the report must indicate the need for training to enable the client to effectively use the recommended equipment

10.7.4 Training programs

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401415 Training program (TP) – Low vision aids LVS/CLVT, GEN Yes 1 training program per client $150 per hour, for a maximum of 4 hours

Follows a low vision aids functional assessment
99401414 Training program (TP) – Orientation and mobility aids LVS/CLVT, COMS GEN Yes 1 training program per client $150 per hour, for a maximum of 18 hours

Follows an orientation and mobility aids functional assessment
99401416 Training program (TP) – Assistive technology aids LVS/CLVT, CVRT, ATS GEN Yes 1 training program per client $150 per hour, for a maximum of 12 hours

Follows an assistive technology aids functional assessment
99401417 Training program (TP) – Independent living aids LVS/CLVT, CVRT GEN Yes 1 training program per client $150 per hour, for a maximum of 6 hours

Follows an independent living aids functional assessment

10.7.5 Servicing

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401418 Repairs     Yes   Minimum of 12 months warranty on repairs
99401267 Delivery, low vision         Delivery of equipment to client

10.8 Other

Item code Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400873 Coloured filters LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes 2 pairs every 2 years  
99400876 Face cradle, rental LVS/CLVT, MD, RN, O.D., OMT, OT, NP GEN Yes   Covered for post-op recovery for vitrectomy surgery

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