11.0 Mobility equipment and supplies benefits list

Effective date: October 19, 2023

The following Medical Supplies and Equipment (MS&E) list contains mobility items and services provided as eligible benefits by the Non-Insured Health Benefits (NIHB) program for eligible First Nations and Inuit, along with information on coverage policies, item codes, requirements for prior approval and applicable recommended replacement guidelines.

11.1 General information
11.2 Seating device
- 11.2.1 Positioning seat
11.3 Standing device
- 11.3.1 Frame
11.4 Walking aid
11.5 Medical stroller
11.6 Wheelchair
- 11.6.1 Manual wheelchair
- 11.6.2 Power wheelchair
11.7 Wheelchair parts
11.8 Accessories
11.9 Servicing

11.1 General information

11.1.1 Benefit policies

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

11.1.2 Prescriber and provider requirements

Prescriptions or recommendations for coverage must be initiated by the health professionals identified as prescribers or recommenders of the specific item as listed in the tables. Items that are 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:

LPN/RPN — Licensed Practical Nurse/Registered Practical Nurse when within their scope of practice in their province/territory (see endnote ^{Footnote 1} and ^{Footnote 2})
MD — Physician
NP — Nurse Practitioner
OT — Occupational Therapist
PT — Physiotherapist
RN — Registered Nurse

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

11.1.3 Prior approval requirements

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

To initiate the prior approval process, the Mobility 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:

the prescription or recommendation or referral form signed by an NIHB-recognized prescriber for the requested benefit
detailed assessment (see appropriate section), including whether specialized equipment (standing frames, walkers, wheelchairs, strollers) has been trialed
additional relevant information the provider, physician, nurse practitioner, occupational therapist, or physiotherapist 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.)

11.1.4 Exclusions

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

equipment with a rated capacity that would be unable to bear the client's weight
scooters

11.1.5 Warranties

providers must honour the manufacturer's warranty
all wheelchairs and medical strollers must carry at a minimum, a one-year warranty

11.1.6 Repairs

The program will cover minor repairs to wheelchairs under a special authorization process. When providers submit a prior approval for a new wheelchair or request a repair to an existing wheelchair, a special authorization will be created to allow the provider to directly claim up to the unit price established in the price file for subsequent repairs. The special authorization will be effective from the device warranty expiration date to the device frequency limit. Repair prices include parts (the program only covers new parts) and labour.

Prior to performing a repair, the provider must communicate with Express Scripts Canada to confirm if prior approval is required. 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 for repairs exceeding the unit price or frequency
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.

11.1.7 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.

All replacement requests require a new prescription.

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

11.1.7.1 Early replacement requirements

Coverage requests for any early replacement require prior approval, a new prescription as well as documentation 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 weight, 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.

11.1.8 Services included in the price

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

initial assessment/equipment trial to determine the type of benefit required
product and parts ordering and delivery from manufacturer to provider (including delivery costs, exchange rate)
dispensing of the item, which includes any required adjustments or fittings at the time of dispensing

11.1.9 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.

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.

Unit price

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

11.2 Seating device

Eligibility criteria:

the client is under the age of majority
the client has a chronic long-term disability requiring support to obtain and/or maintain a seated position
the client has been assessed in the environment where the chair is intended to be used
prior approval is required

Assessment from an occupational therapist or physiotherapist must include:

the need for the item
the client's anthropometric measurements including height and weight
the client's medical, physical status and functional postural/positioning issues
other relevant information
device manufacturer, model, and weight capacity
completed manufacturer's order sheet

11.2.1 Positioning seat

Positioning seats are specialized seating systems (other than wheelchairs, commodes/toileting devices and bath seats) for individuals with disabilities. They are designed to provide positioning support to individuals who are unable to sit in a conventional seat or chair due to decreased postural control, or sensory, behavioural or physical needs. Positioning seats facilitate participation in essential activities of daily living such as feeding, grooming, hygiene, dressing, communication and play.
May be single position or multi-positional (including tilt, recline, and bases and backs with springs). Some positioning seats offer multiple features such as tilt and recline, tilt and backrest with spring, etc.
May include harness or two-point belt, and/or strap option to secure the seat to a chair for tabletop activities.
Available in different models based on client size. May be listed as small, medium, large, etc. For NIHB's purposes, these are coded as infant, school age and toddler, adolescent and bariatric.

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines
99400974	Positioning seat, adolescent	MD, NP, OT, PT	GEN	Yes	1 every 4 years
99400975	Positioning seat, bariatric	MD, NP, OT, PT	GEN	Yes	1 every 4 years
99400972	Positioning seat, infant	MD, NP, OT, PT	GEN	Yes	1 every 4 years
99400973	Positioning seat, toddler and school age	MD, NP, OT, PT	GEN	Yes	1 every 4 years
99400977	Parts, seat device		GEN	Yes

11.3 Standing device

Eligibility criteria:

the client is under the age of majority
the client should have a diagnosis of an underlying medical condition that involves an inability to walk or loss of walking ability
the client has been assessed in the environment of the intended use
if the requested item was adjudicated by a Provincial/Territorial program, this information should be included with the request

Prior approval is required. Assessment from an occupational therapist or physiotherapist must include:

the need for the item
the client's anthropometric measurements including height and weight
the client's medical, physical status and functional postural/positioning issues
other relevant information
device manufacturer, model, and weight capacity
completed manufacturer's order sheet

11.3.1 Frame

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines
99400979	Standing frames, adolescent	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400981	Standing frames, bariatric	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400978	Standing frames, pediatric	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400983	Parts, standing frame		GEN	Yes

11.4 Walking aid

11.4.1 Cane

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400332	Cane, single	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 every 5 years
99400333	Cane, aluminum adjustable quad	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 every 5 years

11.4.2 Crutches

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400335	Crutches axillary, pair, purchase	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 every 5 years
99400336	Crutches axillary, pair, rental	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	Yes		rented for 1 month at a time
99400337	Crutches, specialized, pair, purchase	MD, NP, OT, PT	GEN	No	1 every 5 years	forearm crutches crutches that are custom-made due to client size
99401378	Crutches, bariatric, pair, purchase	MD, NP, OT, PT	GEN	No	1 every 5 years	crutches made from more durable materials (due to client weight) includes bariatric axillary and bariatric forearm crutches minimum weight capacity of 500 lbs

11.4.3 Walker

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400338	Walker, standard, purchase	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 every 5 years	height adjustable (without wheels) includes: hemi or side walkers, OR 2 fixed or removable wheel options on a standard walker the client's weight must be within the weight capacity of the device
99400340	Walker, 4 wheel, purchase	MD, NP, OT, PT	GEN	No	1 every 5 years	sizes: floor to seat height is below: 58.42 cm (23 inches) push handle height: 73.66 to 96.52 cm (29 to 38 inches) width between push handles below: 60.96 cm (24 inches) wheel size: 10.16 to 15.24 cm (4 to 6 inches), 15.24 to 20.32 cm (6 to 8 inches), or 20.32 to 25.4 cm (8 to 10 inches) brakes: must be able to accommodate slow down brakes brakes: none, push-to-lock, or auto stop brake type: none, bilateral, or one hand weight capacity: the client's weight must be within the weight capacity of the device consider the weight of O2 holder when applicable other components: hand grips: none or standard back support: yes or no
99400931	Walker, 2 wheeled, purchase	MD, NP, OT, PT, RN	GEN	No	1 every 5 years
99400934	Walker, 4 wheel, bariatric, purchase	MD, NP, OT, PT	GEN	No	1 every 5 years
99400341	Walker, wheeled, rental	MD, NP, OT, PT, RN	GEN	Yes		rented for 1 month at a time
99400339	Walker, standard, rental	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	Yes		rented for 1 month at a time
99400812	Walker, standard, recycled	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	Yes	1 every 5 years
99400813	Walker, wheeled, recycled	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	Yes	1 every 5 years

11.5 Medical stroller

Eligibility criteria:

the client is under the age of majority
the client has a mobility limitation with an inability to self-propel a mobility device
a medical stroller is the most suitable mobility device to meet the client's long-term needs as a primary mobility device for at least 5 years

Providers must submit the following information:

an occupational therapy or physiotherapy report explaining how the medical stroller will meet the client's functional needs. The report should include the client's:
- medical, physical and functional status, including the client's mobility and transfer status
- client's height and weight
- justification why a medical stroller is required rather than a manual wheelchair
- length of time the stroller is expected to meet the child's needs
- clinical justification for all additional features requested with the medical stroller
- explanation of why a commercial stroller is not suitable

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400891	Medical stroller	MD, NP, OT, PT	GEN	Yes	1 every 5 years

11.6 Wheelchair

Eligibility criteria:

the wheelchair is not available to the client through any other federal, provincial, territorial or third-party health care program
requests for coverage for a wheelchair should be supported by diagnostic and assessment information provided by an occupational therapist or physiotherapist
the wheelchair is intended for use in a home setting or other ambulatory care setting
the wheelchair is medically needed and will meet the client's need for activities of daily living
the client should be able to use their wheelchair in their place of residence to perform their activity of daily living (for example, wheelchair fits within the client's home environment and doorways)
the wheelchair must be the most cost-effective option to meet the client's medical needs
only options and accessories essential for medical or safety reasons may be covered
the wheelchair must be able to meet the client's weight requirements

11.6.1 Manual wheelchair

11.6.1.1 Manual wheelchair without prior approval

Certain manual wheelchairs can be covered without prior approval.

In situations where the client has an above or below knee amputation or in cases where ALL of the conditions below are met:

the wheelchair unit price is below the price listed in the price files on the Express Scripts Canada NIHB provider and client website
the client is a part-time wheelchair user (full-time wheelchair users need a more advanced chair which requires prior approval)
the client is not transferring to a long-term care facility
the client is not in palliative care (NIHB will cover a rental)
the recommended replacement guidelines are respected

Providers must keep on file a copy of the prescription, the assessment report (if available), the order sheet, and the warranty details as described in the manual wheelchair with prior approval section. This information must be submitted if requested for verification purposes.

11.6.1.2 Manual wheelchair with prior approval

Providers must submit the following information for prior approval:

a prescription or recommendation (a prescription is not required when an occupational therapy or physiotherapy report is provided)
an occupational therapy or physiotherapy report explaining how the wheelchair and any additional features, will meet the client's functional needs including the client's:
- the diagnosis(es)
- the client's physical and functional status and the current method of mobilization
- the client's height and weight
- the justification for the client's need for a manual wheelchair to complete activities of daily living
- the number of hours per day that the wheelchair will be used
- the explanation of the client's ability to self-propel
- the confirmation that the manual wheelchair fits within the client's home environment
- the type and model of the wheelchair recommended and the rationale for chosen model
- the dimensions and features of the wheelchair recommended
- the clinical rationale for all additional features and accessories
- the indication that the recommended equipment was trialed
- transfer status
- the clinical rationale indicating why a basic cushion is not recommended
a completed wheelchair order sheet which includes the manufacturer and model/Item number or code
warranty details (including expiration date)

11.6.1.3 Backup manual wheelchair

Clients using a power wheelchair as their primary mobility device may be eligible for the coverage of a standard manual wheelchair as a backup to provide a temporary means for mobility when the power wheelchair is not available (such as when it is in for repairs or maintenance). For coverage, the client must meet NIHB's criteria for a power wheelchair.

A backup manual wheelchair may be covered when:

a power wheelchair is approved by the program

OR
the client has a power wheelchair that was covered by the program or by another provincial/territorial benefit plan to which the NIHB client is eligible

The program may cover a new manual wheelchair for a client who is transitioning from a manual to a power wheelchair only if there is a significant change in the client's medical needs or it is no longer economical to repair the manual wheelchair currently used by the client.

A tilt-in-space manual wheelchair may be covered as a backup for clients with a tilt-in-space power wheelchair

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400349	Wheelchair, manual, purchase	MD, NP, OT, PT	GEN	No	1 every 5 years	weight capacity: overall chair weight is 15.42 kg (34 lb) or less the client's weight must be within the weight capacity of the device sizes: seat: up to 45.72 cm x 45.72 cm (18 inches x 18 inches) urethane rear tires with mag rims: 60.96 cm (24 inches) front solid casters: 20.32 cm (8 inches) other components: standard swing-away footrests standard back upholstery adjust adjustable height flip-back or detachable armrests with fill arm pads push to lock brakes
99400350	Wheelchair, manual, rental	MD, NP, OT, PT	GEN	Yes		rented for 1 month at a time
99400814	Wheelchair, manual, recycled, purchase	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400942	Backup manual w/c purchase	MD, NP, OT, PT	GEN	Yes	1 every 5 years

11.6.2 Power wheelchair

Eligibility criteria in addition to general wheelchair eligibility:

the client or caregiver must be able to care for a power wheelchair and keep batteries charged
the client must be able to safely, independently and with good judgment operate a power wheelchair
the wheelchair is the client's primary mobility device
the wheelchair is needed for indoor use to meet client's need for activities of daily living

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400785	Power wheelchair, purchase	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400815	Power wheelchair, recycled, purchase	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400918	Power wheelchair, rental	MD, NP, OT, PT	GEN	Yes		rented for 1 month at a time

11.7 Wheelchair parts

11.7.1 Back support

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines
99400357	Back support, adult	MD, NP, OT, PT	GEN	Yes	1 every 3 years
99400660	Back support, child	MD, NP, OT, PT	GEN	Yes	1 every 2 years
99400662	Back support cover, adult	MD, NP, OT, PT	GEN	Yes	1 every 2 years
99400661	Back support cover, child	MD, NP, OT, PT	GEN	Yes	1 every 2 years

11.7.2 Seat cushion

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines
99400361	Seat cushion cover, adult	MD, NP, OT, PT	GEN	Yes	1 every 2 years
99400363	Seat cushion, adult	MD, NP, OT, PT	GEN	Yes	1 every 3 years
99400668	Seat cushion cover, child	MD, NP, OT, PT	GEN	Yes	1 every 2 years
99400669	Seat cushion, child	MD, NP, OT, PT	GEN	Yes	1 every 2 years

11.7.3 Arm rest

Item code	Item name	Prescriber	Provider	Prior approval required
99400372	Arm rest, fixed support, 1pc	MD, NP, OT, PT	GEN	Yes
99400674	Arm rest, fixed support, 1pc, pads	MD, NP, OT, PT	GEN	Yes
99400675	Arm rest, fixed support, 1pc, hardware	MD, NP, OT, PT	GEN	Yes
99400676	Arm rest, fixed support, multi component	MD, NP, OT, PT	GEN	Yes
99400677	Arm rest, fixed support, multi component, pad	MD, NP, OT, PT	GEN	Yes
99400678	Arm rest, fixed support, multi component, hardware	MD, NP, OT, PT	GEN	Yes
99400679	Arm rest, movable	MD, NP, OT, PT	GEN	Yes

11.7.4 Calf

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400681	Calf board, child	MD, NP, OT, PT	GEN	Yes
99400682	Calf board, adult	MD, NP, OT, PT	GEN	Yes

11.7.5 Caster

Item code	Item name	Prescriber	Provider	Prior approval required
99400376	Caster	MD, NP, OT, PT	GEN	Yes
99400377	Caster fork	MD, NP, OT, PT	GEN	Yes
99400378	Caster housing	MD, NP, OT, PT	GEN	Yes
99400379	Caster housing dust cover	MD, NP, OT, PT	GEN	Yes
99400380	Caster plate	MD, NP, OT, PT	GEN	Yes

11.7.6 Head-neck rest

Item code	Item name	Prescriber	Provider	Prior approval required
99400707	Neck rest, adjustable, child	MD, NP, OT, PT	GEN	Yes
99400708	Neck rest, adjustable, adult	MD, NP, OT, PT	GEN	Yes
99400709	Neck rest with headrest, adjustable, child	MD, NP, OT, PT	GEN	Yes
99400710	Neck rest with headrest, adjustable, adult	MD, NP, OT, PT	GEN	Yes
99400694	Head rest	MD, NP, OT, PT	GEN	Yes

11.7.7 Foot

Item code	Item name	Prescriber	Provider	Prior approval required
99400383	Footplate	MD, NP, OT, PT	GEN	Yes
99400683	Footplate extension	MD, NP, OT, PT	GEN	Yes
99400684	Footrest	MD, NP, OT, PT	GEN	Yes
99400690	Foot box, child	MD, NP, OT, PT	GEN	Yes
99400691	Foot box, adult	MD, NP, OT, PT	GEN	Yes
99400692	Foot pocket, child	MD, NP, OT, PT	GEN	Yes
99400693	Foot pocket, adult	MD, NP, OT, PT	GEN	Yes

11.7.8 Stabilizer

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines
99400367	Pelvic stabilizer, one side, adult	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400368	Pelvic stabilizer, pair, adult	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400666	Pelvic stabilizer, one side, child	MD, NP, OT, PT	GEN	Yes	1 every 3 years
99400667	Pelvic stabilizer, pair, child	MD, NP, OT, PT	GEN	Yes	1 every 3 years

11.7.9 Interface mounting

Item code	Item name	Prescriber	Provider	Prior approval required
99400702	Interfacing/mounting, strap, child	MD, NP, OT, PT	GEN	Yes
99400703	Interfacing/mounting, seat, simple	MD, NP, OT, PT	GEN	Yes
99400704	Interfacing/mounting, back, simple	MD, NP, OT, PT	GEN	Yes
99400705	Interfacing/mounting, simple	MD, NP, OT, PT	GEN	Yes
99400706	Interfacing/mounting, complex	MD, NP, OT, PT	GEN	Yes

11.7.10 Pommel

Item code	Item name	Prescriber	Provider	Prior approval required
99400711	Pommel, fixed, child	MD, NP, OT, PT	GEN	Yes
99400712	Pommel, fixed, adult	MD, NP, OT, PT	GEN	Yes
99400713	Pommel, removable, child	MD, NP, OT, PT	GEN	Yes
99400714	Pommel, removable, adult	MD, NP, OT, PT	GEN	Yes

11.7.11 Positioning

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines
99400715	Positioning, ankle	MD, NP, OT, PT	GEN	Yes
99400716	Positioning, butterfly	MD, NP, OT, PT	GEN	Yes
99400375	Positioning, calf	MD, NP, OT, PT	GEN	Yes
99400717	Positioning, chest	MD, NP, OT, PT	GEN	Yes
99400718	Positioning, complex	MD, NP, OT, PT	GEN	Yes
99400719	Positioning, pads	MD, NP, OT, PT	GEN	Yes
99400392	Positioning/pelvic belt, adult	MD, NP, OT, PT	GEN	Yes
99400720	Positioning/pelvic belt, child	MD, NP, OT, PT	GEN	Yes
99400881	Amputation board	MD, NP, OT, PT	GEN	Yes	1 every 5 years

11.7.12 Tray

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines
99400721	Wheelchair tray, elevating, child	MD, NP, OT, PT	GEN	Yes	1 every 2 years
99400722	Wheelchair tray, elevating, adult	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400723	Wheelchair tray, standard, child	MD, NP, OT, PT	GEN	Yes	1 every 2 years
99400724	Wheelchair tray, standard, adult	MD, NP, OT, PT	GEN	Yes	1 every 5 years
99400725	Wheelchair tray, tilting, child	MD, NP, OT, PT	GEN	Yes	1 every 2 years
99400726	Wheelchair tray, tilting, adult	MD, NP, OT, PT	GEN	Yes	1 every 5 years

11.7.13 Other wheelchair parts

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400373	Axle plate	MD, NP, OT, PT	GEN	Yes
99400882	Batteries, power wheelchair, pair		GEN	Yes	1 per year
99400883	Brakes	MD, NP, OT, PT	GEN	Yes
99400381	Crossbrace	MD, NP, OT, PT	GEN	Yes
99400382	Elevating leg rest/footrest	MD, NP, OT, PT	GEN	Yes
99400384	Front rigging	MD, NP, OT, PT	GEN	Yes
99400385	Growable frame	MD, NP, OT, PT	GEN	Yes
99400386	Handrim	MD, NP, OT, PT	GEN	Yes
99400387	Heel loop	MD, NP, OT, PT	GEN	Yes
99400396	Wheel lock	MD, NP, OT, PT	GEN	Yes
99400388	Push handle/backrest tube	MD, NP, OT, PT	GEN	Yes
99400389	Push to lock wheel locks	MD, NP, OT, PT	GEN	Yes
99400390	Quick release axle pin	MD, NP, OT, PT	GEN	Yes
99400391	Rear wheel hub	MD, NP, OT, PT	GEN	Yes
99400393	Seat sling/rigid	MD, NP, OT, PT	GEN	Yes
99400394	Spokes	MD, NP, OT, PT	GEN	Yes
99400395	Tire	MD, NP, OT, PT	GEN	Yes
99400943	Miscellaneous parts, wheelchair, manual		GEN	Yes		For items in this category, a prescription is required when the item is part of a wheelchair request. No prescription is required for items that are requested for a repair.
99400944	Miscellaneous parts, wheelchair, power		GEN	Yes

11.8 Accessories

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines
99400343	Crutches, hand grips, 1 pair	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	2 per year
99400344	Crutches, pads, 1 pair	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	2 per year
99400345	Crutches, tips (ice picks), 1 pair	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 every 2 years
99400346	Crutches, tips (rubber), 1 pair	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 per year
99401319	Forearm attachments for walker, left	MD, NP, OT, PT, RN	GEN	Yes	1 every 5 years
99401320	Forearm attachments for walker, right	MD, NP, OT, PT, RN	GEN	Yes	1 every 5 years
99400347	Walker, glide brakes, 1 pair	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 every 2 years
99401321	Slowdown brakes for walker	MD, NP, OT, PT, RN	GEN	Yes	1 every 5 years
99400348	Walker, wheel, 1 pair	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 every 2 years
99400879	Skis for walker, set of 2	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}N	GEN	No	1 every 2 years
99400880	Tray/pouch, walker	MD, NP, OT, PT, RN, LPN/RPN^{Footnote 1} ^{Footnote 2}	GEN	No	1 every 5 years

11.9 Servicing

11.9.1 Repairs

Item code	Item name	Provider	Prior approval required	Additional details
99400342	Repair, walker	GEN	Yes
99400673	Repair, wheelchair cushion/backrest/seat	GEN	Yes
99401201	Repair, wheelchair, power	GEN	Yes	Prior approval is not required for 1 repair per year after warranty expires within established price.
99401223	Repair, wheelchair, manual	GEN	Yes
99400976	Repair, seating device	GEN	Yes	only covered when the manufacturer warranty has elapsed 90-day warranty on repairs
99400982	Repair, standing frame	GEN	Yes

11.9.2 Delivery

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99400819	Delivery of equipment		GEN	Yes

11.9.3 Labour

Item code	Item name	Prescriber	Provider	Prior approval required	Recommended replacement guidelines	Additional details
99401144	Labour, wheelchair		GEN	Yes

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Date modified:: 2023-10-19