12.0 Communication equipment and supplies benefits list

Effective date: September 14, 2022

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12.1 General information

12.1.1 Benefit policies

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

12.1.2 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 reversals of claims.

The following is a list of NIHB recognized prescribers/recommenders 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
  • OT — Occupational Therapist
  • SLP — Speech-language Pathologist

The following is a list of NIHB recognized providers 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

12.1.3 Prior approval requirements

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

12.1.3.1 Voice restoration and laryngectomy supplies

To initiate the prior approval process for voice restoration and for laryngectomy supplies, complete the Communication – Voice Restoration and Laryngectomy Supplies Prior Approval Form, found on the Express Scripts Canada NIHB provider and client website and submit to your NIHB regional office along with the following supporting documentation:

  • the prescription/recommendation or referral form signed by an NIHB recognized prescriber for the requested benefit
  • assessment within the last 12 months for voice prosthesis and speaking valve:
    • assessment must be by a specialized speech-language pathologist (SLP) which provides a diagnosis and describes the client's current condition in relation to his/her laryngectomy or tracheostomy, and which indicates that the client is a good candidate and would benefit from these devices
  • additional relevant information the provider, physician, nurse practitioner, or speech-language pathologist 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.)

12.1.3.2 Augmentative and alternative communication (AAC)

1) In all provinces and territories (including Ontario if items are not covered by the Assistive Devices Program (ADP)):

To initiate the prior approval process for AAC benefits, complete the Augmentative and Alternative Communication (AAC) Requisition and Prior Approval Form, found on the Express Scripts Canada NIHB provider and client website and submit to your NIHB regional office along with the following supporting documentation:

  • the Augmentative and Alternative Communication (AAC) Assessment Form signed by an NIHB recognized prescriber for the requested benefit

    or

    a speech-language pathology (SLP) assessment report that includes a prescription and recommendation/s, signed by an NIHB recognized prescriber for the requested benefit. If access or mounting equipment are prescribed, an occupation therapy assessment report must also be included
  • additional relevant information the provider, physician, nurse practitioner, or speech-language pathologist 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: If a speech-language pathology/occupational assessment report is submitted, the clinician must include all the information related to the client's language abilities that is required in the Augmentative and Alternative Communication (AAC) Assessment Form.

2) In Ontario where items are covered by the Assistive Device Program (ADP):

To initiate the prior approval process for AAC benefits, complete the Augmentative and Alternative Communication (AAC) Requisition and Prior Approval Form, found on the Express Scripts Canada NIHB provider and client website, and submit to the NIHB regional office along with the following supporting documentation:

  • the ADP application form in lieu of the Augmentative and Alternative Communication (AAC) Assessment Form

12.1.4 Exclusions

The general exclusion policy is listed in the general policies.

12.1.5 Warranties

Providers must honour the manufacturer's warranty.

12.1.6 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.

12.1.7 Replacement requirements

To be eligible for replacement the item must meet ONE of the following conditions:

  • be outside the recommended replacement guideline
  • not working, outside of warranty and the cost of repair exceeds the cost of a new item
  • the item no longer meets the client's needs due to a change in medical condition

All requests for replacement require a new prescription. If an item is required before the recommended replacement guidelines, documentation supporting the need for early replacement must be provided.

12.1.8 Services included in the price

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
  • a markup to the price of AAC equipment and accessories is not accepted, the provider must claim the catalog price

12.1.9 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 a 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.

Recommended replacement guidelines

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

Unit price

Unit price information may be found on the price files, located on the Express Scripts Canada NIHB provider and client website.

12.2 Voice restoration

12.2.1 Coverage criteria

Voice prosthesis and electrolarynx:

  • the client has undergone a total laryngectomy
  • the special order indwelling voice prosthesis must meet the following additional criteria:
    • a speech-language pathologist must provide a medical rationale indicating why a standard indwelling voice prosthesis is not appropriate
    • indication from the speech-language pathologist that a standard prosthesis was trialed but was found to be insufficient/ineffective or caused medical issues that interfered with voice production

12.2.2 Voice restoration device

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400993 Electrolarynx MD, NP, SLP GEN Yes 1 every 4 years  
99401254 Hands free speaking valve MD, NP, SLP GEN Yes 1 set of 3 valves per year Client has undergone a laryngectomy
99400193 Speaking valve MD, NP, SLP GEN Yes 4 per year Client has undergone a tracheostomy
99400994 Voice amplifier MD, NP, SLP GEN Yes 1 every 4 years Client presents with a neurological or structural problems that reduces speech volume
99400985 Voice prosthesis, indwelling, regular MD, NP, SLP GEN Yes 4 per year  
99400986 Voice prosthesis, indwelling, special order MD, NP, SLP GEN Yes 4 per year  
99400984 Voice prosthesis non-indwelling MD, NP, SLP GEN Yes 10 per year  

12.2.3 Voice prosthesis supplies

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400989 Cleaning brush MD, NP, SLP GEN Yes 2 boxes per year  
99400990 Flushing device MD, NP, SLP GEN Yes 1 box per year Client has undergone a laryngectomy
99400988 Gel cap insertion system MD, NP, SLP GEN Yes 1 per year Client has undergone a tracheostomy
99400992 Gel cap replacement MD, NP, SLP GEN Yes 1 box per year Client presents with a neurological or structural problems that reduces speech volume
99400991 Plug insert MD, NP, SLP GEN Yes 2 per year  
99400987 Puncture dilator MD, NP, SLP GEN Yes 1 per year  

12.3 Augmentative and alternative communication (AAC)

12.3.1 Coverage criteria

  • client has a moderate to severe communication impairment and communication needs (as determined by a Speech-Language Pathologist) which cannot be met by using speech alone
  • client has a long-term disability (speech or otherwise) and requires an augmentative and alternative communication device for personal use for a minimum of 6 months, or client is identified as palliative
  • devices cannot be prescribed for the purpose of acquiring new communication skills and therefore not prescribed as a therapy tool
  • in the Province of Ontario, clinician must first apply to the Assistive Devices Program (ADP) for coverage of the augmentative and alternative communication item prior to the application to the NIHB program. NIHB will cover the portion of the cost not covered by the Assistive Devices Program

12.3.2 Required information for open benefits

The Augmentative and Alternative Communication (AAC) Requisition and Prior Approval Form (section A) must be completed and submitted when requesting items that are an open benefit (no prior approval required).

12.3.3 Requirements for integrated and complex systems

  • clinician must provide a clinical rationale for prescribing a particular product, for example, explain what features of the requested model are required that are not available in a more cost-effective model, and explain how those features will meet the client's needs. If this information is missing, it may lead to a delay in reviewing the request
  • device must be trialed successfully
  • client must have access to clinical follow-up by a speech-language pathologist for training purposes

12.3.4 Process for submitting requests

The following processes describe how to submit requests for limited use benefits (requiring prior approval) and for open benefits (do not require prior approval).

12.3.4.1 For all of Canada except in Ontario where items are covered by the Ontario Assistive Devices Program (ADP):

Please note, in the Province of British Columbia, the Program provides coverage for recognized Inuit and non-resident First Nations.

1) Process for submitting requests for limited use benefits (prior approval required):

Step 1

The clinician:

  • completes the Augmentative and Alternative Communication (AAC) Requisition and Prior Approval Form, section A (one form per provider)
  • sends the form to the NIHB enrolled provider(s)
Step 2

The provider:

  • completes the Augmentative and Alternative Communication (AAC) Requisition and Prior Approval Form, section B
  • sends the completed form back to the clinician
Step 3

The clinician:

  • faxes the following forms to the NIHB Regional office:
    • the Augmentative and Alternative Communication (AAC) Requisition and Prior Approval Form(s)
      and
    • the Augmentative and Alternative Communication (AAC) Assessment Form completed by the clinician or an SLP/OT assessment report
Step 4

NIHB:

  • NIHB regional office reviews the documents
  • A letter is sent to the provider to communicate the decision (approved, denied, on hold). If approved, a prior approval number will be provided
Step 5

The provider:

  • advises the clinician that the request has been approved and that the item will be dispensed to the client/clinic
  • submits the MS&E Claim Form to Express Scripts Canada for reimbursement

2) Process for submitting request for open benefit (prior approval not required):

Step 1

The clinician:

  • completes the Augmentative and Alternative Communication (AAC) Requisition and Prior Approval Form, section A
  • sends the signed form to the provider
Step 2

The provider:

  • dispenses the item(s) to the clinic or the client
  • submits the MS&E Claim Form to Express Scripts Canada for reimbursement

12.3.4.2 For items covered by the Ontario Assistive Devices Program (ADP):

Process for submitting requests for limited use and open benefits:

Step 1

ADP authorizer:

  • authorizer completes the Augmentative and Alternative Communication (AAC) Form, section A
  • authorizer submits this form along with the ADP application form to the centralized equipment pool (CEP) (or other NIHB provider)
Step 2

Provider: CEP or other NIHB provider:

  • provider completes the Augmentative and Alternative Communication (AAC) Requisition and Prior Approval Form, section B, and submits it to the Ontario NIHB Regional office
Step 3

NIHB:

  • approval letter is sent to provider with a prior approval number. This number is to be included in the MS&E Claim Form
Step 4

Provider:

  • provider submits the MS&E Claim Form to Express Scripts Canada with the prior approval number

Note: A list of NIHB regional fax numbers is provided on each of the NIHB forms listed above. These forms can be found on the Express Scripts Canada NIHB provider and client website.

12.3.5 Quick messaging device

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401296 Quick messaging device SLP, OT GEN No 1 every 2 years Examples: Big Mac, Step by Step, etc.

12.3.6 Speech generating device

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401300 Simple speech generating device SLP GEN Yes 1 every 3 years Devices with static display, digitized speech and simple programming options. Messages are simple with limited vocabulary, primarily word or phrase based. Examples: Go Talk, Quick Talker or Simple Speech Generating System (up to three quick messaging devices), etc.
99401302 Speech generating device, lease/rental SLP GEN Yes Voice output communication aids used to supplement or replace speech or writing. They may allow for support of alternative access and integrated capabilities that could allow the device to be more complex. Examples: Lightwriter, Allora 2, NovaChat, Accent (800, 1000 or 1400), Via Pro, etc.
99401301 Speech generating device, purchase SLP GEN Yes 1 every 5 years Voice output communication aids used to supplement or replace speech or writing. They may allow for support of alternative access and integrated capabilities that could allow the device to be more complex. Examples: Lightwriter, Allora 2, NovaChat, Vibe, Accent (800, 1000 or 1400), Via Pro, etc.
99401303 iOS speech tablet package SLP GEN Yes 1 every 4 years Package may include:
  • tablet
  • communication application
  • case
  • screen protector
  • stylus


Example: iPad speech tablet package.
99401315 Speech tablet package SLP GEN Yes 1 every 4 years Package may include:
  • tablet
  • communication application
  • case
  • screen protector
  • stylus


Example: Tobii Dynavox Indi speech tablet package.

12.3.7 Software

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401297 Communication display making software SLP GEN No 1 every 3 years Examples: Boardmaker, SymWriter, etc.
99401299 Software for speech generating device, lease/rental SLP GEN Yes Examples: Proloquo2go, Proloquo4text, WordPower, TouchChat, Grid 3, Mind Express, Essence, etc.
99401298 Software for speech generating device, purchase SLP GEN Yes 1 every 3 years Examples: Proloquo2go, Proloquo4text, WordPower, TouchChat, Grid 3, Mind Express, Essence, etc.

12.3.8 Communication display board

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401293 Non-electronic communication system SLP GEN No 1 every 6 months Static based communication system. Examples: Paper-based communication boards, eye gaze board, communication books, Podd books, etc.

12.3.9 Integrated and complex systems

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401295 Integrated and complex system, lease/rental SLP GEN Yes Communicators must be able to use words and phrases to speak a message. Examples: Grid pad, Tellus 5, Tobii I-13, I-16, I-110, Accent 1000 or 1400 with Look module, Tobii 15, etc.
99401294 Integrated and complex system, purchase SLP GEN Yes 1 every 5 years Communicators must be able to use words and phrases to speak a message. Examples: Grid pad, Tellus 5, Tobii I-13, I-16, I-110, Accent 1000 or 1400 with Look module, Tobii 15, etc.

12.3.10 Switch and mounting system

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401312 Complex mounting system for access hardware, lease/rental OT GEN Yes Complex mounting system to mount an access device to a wheelchair, or other vehicle.
99401311 Complex mounting system for access hardware, purchase OT GEN Yes 1 every 3 years Complex mounting system to mount an access device to a wheelchair, or other vehicle.
99401310 Complex mounting system for device, lease/rental OT GEN Yes Complex system for mounting a communication device to a wheelchair, or other vehicle.
99401309 Complex mounting system for device, purchase OT GEN Yes 1 every 3 years Complex system for mounting a communication device to a wheelchair, or other vehicle.
99401306 Complex switch, lease/rental OT GEN Yes May include switch interface.
99401305 Complex switch, purchase OT GEN Yes 1 every 2 years May include switch interface.
99401308 Simple mounting system access OT, SLP GEN No 1 every 5 years For output (for example: switch, head pointer, etc.)
99401307 Simple mounting system device OT, SLP GEN No 1 every 5 years For speech generating devices, IPad, etc.
99401304 Simple switch OT, SLP GEN No 5 per year Examples:
Aero/Freedom, Big buddy switch, Big Red, Buddy Button, etc.

12.3.11 Batteries

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401282 Batteries for switch or pointer SLP, OT GEN No 4 batteries every 6 months AA or AAA batteries.

12.3.12 Accessories

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401283 Carrying case for speech generating device SLP GEN No 1 every 5 years Can include a shoulder strap or a screen protector.
99401289 Keyguard for speech generating device, lease/rental SLP, OT No Example: Touch guide, etc.
99401288 Keyguard for speech generating device, purchase SLP, OT GEN No 1 every 5 years Example: Touch guide, etc.
99401314 Mouse alternative, lease/rental OT GEN Yes Circuitry to provide alternate mouse control. For example, a head mouse which is controlled through head movements. It provides reliable hands-free mouse control for individuals who are unable to use a traditional manual computer mouse to control their communication device. Examples: Tracker Pro, Irisbond Duo Camera, PC Eye plus, NuPoint, etc.
99401313 Mouse alternative, purchase OT GEN Yes 1 every 3 years Circuitry to provide alternate mouse control. For example, a head mouse which is controlled through head movements. It provides reliable hands-free mouse control for individuals who are unable to use a traditional manual computer mouse to control their communication device. Examples: Tracker Pro, Irisbond Duo Camera, PC Eye Plus, NuPoint, etc.
99401285 Pointer, lease/rental OT GEN No Non-computerized
99401284 Pointer, purchase OT GEN No 1 every 5 years Non-computerized
99401291 Power converter, wheelchair accessory, lease/rental OT No This is a converter for a power wheelchair. This converter uses the power of the wheelchair to power the communication device.
99401290 Power converter, wheelchair accessory, purchase OT GEN No 1 every 3 years This is a converter for a power wheelchair. This converter uses the power of the wheelchair to power the communication device.
99401287 Speech generating device access hardware, lease/rental OT GEN Yes Enhanced switch circuitry: This equipment is an alternative method used by a client with a disability for operating their speech device if they are unable to use a keyboard or other standard input method. Examples: Eye gaze tracking systems, the Look module, Eye module for Tobii 15, etc.
99401286 Speech generating device access hardware, purchase OT GEN Yes 1 every 5 years Enhanced switch circuitry: This equipment is an alternative method used by a client with a disability for operating their speech device if they are unable to use a keyboard or other standard input method. Examples: Eye gaze tracking systems, Look module, Eye module for Tobii 15, etc.
99401292 Wheelchair control unit (input/output module) OT GEN Yes 1 every 3 years This is a converter for a power wheelchair. This converter uses the drive controls (for example, joy stick) of the wheelchair to control a communication device. It allows the drive control to talk to another circuitry such as the mouse alternative. For example, the joystick of the wheelchair can be used as a joystick mouse to control the communication device.

12.4 Laryngectomy Supplies

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400476 Adhesive removers MD, NP, SLP, NSWOC, WOCC (C) GEN No 6 boxes per year  
99401241 Cleaning towels MD, NP, SLP GEN No 2 boxes per year  
99401233 Heat & moisture exchanger (HME), specialized MD, NP, SLP GEN No 1 per day  
99401232 Heat & moisture exchanger (HME), standard MD, NP, SLP GEN No 1 per day  
99401235 Heat & moisture exchanger, housing/baseplate, specialized MD, NP, SLP GEN No 1 per day  
99401234 Heat & moisture exchanger, housing/baseplate, standard
MD, NP, SLP GEN No 1 per day  
99401243 Laryclip MD, NP, SLP GEN No 12 per year  
99401237 Laryngectomy button MD, NP, SLP GEN No 2 per year  
99401236 Laryngectomy tube MD, NP, SLP GEN No 2 per year  
99401238 Laryngectomy tube holder MD, NP, SLP GEN No 12 per year  
99401240 Shower cover MD, NP, SLP GEN No 1 per year  
99401253 Skin barrier wipes MD, NP, SLP GEN No 7 boxes per year  
99401242 Adhesive wipes MD, NP, SLP GEN No 7 boxes per year  
99401239 Stoma cover MD, NP, SLP GEN No 4 per year  

12.5 Servicing

12.5.1 Delivery

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401268 Delivery, communication   GEN Yes   Delivery of equipment to the client.

12.5.2 Repairs

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99401281 Repairs, augmentative and alternate communication Yes Minimum of 12 months warranty on repairs.
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