11.0 Mobility equipment and supplies benefits list

Effective date: September 14, 2022

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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 reversals 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 wheelchair 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. Repairs 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

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 other requests for replacement require a new prescription and a medical justification. A copy of the prescription and prescriber number must be kept in the clients file at the provider's office with all replacements.

If an item is required before the recommended replacement guidelines, documentation supporting the need for early replacement must be provided.

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 to determine the type of benefit required
  • product and parts ordering and delivery from manufacturer to provider (including delivery costs, exchange rate)
  • adjustments or fittings
  • dispensing of the benefit

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 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.

11.2 Seating device

Eligibility criteria:

Assessment from occupational therapist or physiotherapist must include:

11.2.1 Positioning seat

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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:

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

11.3.1 Frame

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400332 Cane, single MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN No 1 per lifetime
99400333 Cane, aluminum adjustable quad MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN No 1 per lifetime

11.4.2 Crutches

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400335 Crutches axillary, pair, purchase MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN No 1 every 2 years
99400336 Crutches axillary, pair, rental MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN Yes
99400337 Crutches, specialized, pair, purchase MD, NP, OT, PT GEN Yes 1 every 5 years
  • forearm crutches
  • crutches made from more durable materials (due to client weight and/or rugged terrain)
  • crutches that are custom-made due to client size

11.4.3 Walker

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400338 Walker, standard, purchase MD, NP, OT, PT, RN, LPN/RPNFootnote 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
99400339 Walker, standard, rental MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN Yes
99400812 Walker, standard, recycled MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN Yes 1 every 5 years
99400813 Walker, wheeled, recycled MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN Yes 1 every 5 years

11.5 Medical stroller

NIHB provides coverage for a medical stroller when there is a presence of mobility limitations with an inability to self-propel a mobility device and confirmation from an occupational therapist or physiotherapist indicating the medical stroller is the most suitable device to meet the client's needs as the primary mobility device and will meet the client's long-term needs for 5 years.

Providers must submit the following information:

Item number 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:

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 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 number 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
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 number 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

11.7 Wheelchair parts

11.7.1 Back support

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number 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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
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 number 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 number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400343 Hand grip, crutches MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN No 2 per year
99400344 Pads, crutches MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN No 2 per year
99400345 Tips (ice picks), crutches MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN No 1 every 2 years
99400346 Tips (rubber), crutches MD, NP, OT, PT, RN, LPN/RPNFootnote 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 Glide brakes, walker MD, NP, OT, PT, RN, LPN/RPNFootnote 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 Wheel, walker MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN No 1 every 2 years
99400879 Skis, walker, set of 2 MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2N GEN No 1 every 2 years
99400880 Tray/pouch, walker MD, NP, OT, PT, RN, LPN/RPNFootnote 1 Footnote 2 GEN No 1 every 5 years

11.9 Servicing

11.9.1 Repairs

Item number Item name Prescriber Provider Prior approval required Recommended replacement guidelines Additional details
99400342 Repair, walker GEN Yes
99400673 Repair, wheelchair cushion/backrest/seat GEN Yes
99401201 Repair, wheelchair, power GEN Yes
  • Prior approval 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
99400982 Repair, standing frame GEN Yes

11.9.2 Delivery

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

11.9.3 Labour

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