DME Restrictions and Guidelines PLEASE NOTE: This list is not all-inclusive, as updates may occur periodically. Refer to the Fee Schedule for pricing and individual code prior authorization information. Restriction
ADHESIVE TAPE LTD TO 240 UNITS PER 30 DAYS
BED, HOSPITAL, MANUAL; LTD 1 PER 8 YEARS
BEDRAILS, HALF AND FULL; LTD TO 1 PAIR EACH PER 5 YEARS
BEDSIDE URINARY DRAINAGE BAGS LTD 12 PER 365 DAYS
CATHETER INSERTION TRAYS LTD TO 12 PER 365 DAYS
CATHETERS, EXTERNAL; LTD TO 31 PER CALENDAR MONTH
CATHETERS, I&O; LTD TO 120 PER CALENDAR MONTH
COMPRESSION GARMENTS LIMITED TO 3 PER LEG PER 365 DAYS
COMPRESSOR NEBULIZER LTD TO 1 PER 3 YEARS
CPAP - CUSHION FOR NASAL MASK INTERFACE LTD TO 2 PER 30 DAYS
CPAP - DISPOSABLE FILTER LTD TO 2 PER 30 DAYS
CPAP - EXHALATION PORT LTD TO 1 PER 180 DAYS
CPAP - FACE MASK INTERFACE LTD TO 1 PER 30 DAYS
CPAP - NASAL INTERFACE LTD TO 1 PER 90 DAYS
CPAP - NON-DISPOSABLE FILTER LTS TO 1 PER 180 DAYS
CPAP - ORAL CUSHION FOR MASK LTD. 2 PER 30 DAYS
CPAP - ORAL INTERFACE LTD TO 1 PER 180 DAYS
CPAP - PILLOW FOR MASK/NASAL CANULA INTERFACE LTD. TO 1 PAIR PER 30 DAYS
CPAP - WATER CHAMBER FOR HUMIDIFIER LTD TO 1 PER 180 DAYS
DIABETIC BLOOD GLUCOSE TESTSTRIPS LTD 36 PER 6 MONTHS
DIABETIC LANCET LTD 18 UNITS PER 6 MONTHS
DIABETIC SYRINGES LTD TO 100 PER 30 DAYS
DISPOSABLE INCONT PRODUCTS LIMIT 300 PER CALENDAR MONTH
DRESSING, DIABETIC TRANSPARENT; LTD.TO 50 DRESSINGS PER CALENDAR
DRESSING, SPEC ABSORPTIVE; LIMITED TO 30 PER CALENDAR MONTH
DRESSINGS, GAUZE; LIMITED TO 400 PER CALENDAR MONTH
ENTERAL AND PARENTERAL SUPPLIES LTD TO ONE TYPE PER DAY
ENTERAL SUPPLIES LTD TO $200.00 PER CALENDAR MONTH
GLOVES, NON-STERILE; LIMITED TO 1200 PER 365 DAYS
GLOVES, STERILE; LIMITED TO 50 PAIR PER MONTH
GLUCOMETERS LIMITED TO ONE PER FIVE YEARS.
GRADIENT PRESSURE AIDES LIMITED TO 3 PER ARM PER 365 DAYS (Includes BREAST PROSTHESES; MASTECTOMY SLEEVE)
GRADIENT STOCKING GARTER BELT LIMITED TO 2 PER 365 DAYS
HEEL PAD WITH SPUR DEPRESSION LTD TO 2 PER FOOT PER 365 DAYS
INFUSION SET FOR EXT INSULIN PUMP LTD 190 PER 365 DAYS
KLING TYPE BANDAGES LTD TO 240 YARDS PER 30 DAYS
LIMIT REPLACEMENT SLING TO ONE PER 365 DAYS
MASTECTOMY BRAS LIMITED TO 2 PER CALENDAR YEAR
MASTECTOMY FORMS LTD TO 1 PER SIDE PER YEAR
OCULAR PROSTHESIS POLISHING AND CLEANING LTD TO ONCE PER 365 DAYS cleaning
ORTHOTIC INSERTS LTD.TO PER FOOT Per 180 days
OSTOMY BARRIERS LTD TO 15 PER CALENDAR MONTH
OSTOMY BELTS ADJUSTABLE; LTD TO 3 PER 365 DAYS
OSTOMY POUCHES, CLOSED; LTD TO 45 PER 30 DAYS
OSTOMY POUCHES, DRAINABLE; LTD TO 15 PER 30 DAYS
PRESSURE-DISPLCNG ANKLE/FOOT ORTHTC LTD 1 PER FOOT PER 2 YEARS
PROSTHETIC HAND REPLCEMENTS LTD 1 PER HAND PER 5 YEARS
REUSABLE INCONTINENCE PRODCUTS LTD 36 PER 365 DAYS
SHOE MODIFICATIONS LTD TO 1 FOOT PER PER 180 DAYS
ORTHOTIC FOOTWEAR LTD 1 PER FOOT PER 180 DAYS
SYRING W NEEDLE FOR EXT INFUSION PUMP 15 PER 30 DAYS
URINE TEST LABS/STRIPS LTD TO 100 PER 90 DAYS
OSTOMY RING LIMITED TO 30 PER 2 MONTH PERIOD
TEST MATERIAL FOR INR MONITORING LTD 1 PER 30 DAYS
HEARING AID REPAIRS LTD TO 1 RT PER 365 DAYS
PERCUSSOR LTD 1MONTH RENTAL & 1 PURCHASE/5 YEARS
FEEDER BOTTLES LIMITED TO 10 IN 180 DAYS
L8501, SPEAK VALVE, LIMITED TO 2 PER 6 MONTHS
RENTAL OF E2402 IS LIMITED TO 1 PER MONTH
1 unit = 1 pump month1 unit = 1 wound care
INSULIN INFUSION PUMP LTD TO 1 IN 4 YEARS
EXTERNAL TRANSMITTER A9277 LIMITED TO 1 IN 365 DAY
DIABETIC CALIBRATION SOLUTION LTD.TO ONCE PER MON.
State variable changes to avoid non computational issues Abstract fer function, like the grid of a triode. But the ideas we aregoing to expose will remain the same. This paper is about the numerical simulation of nonlinearanalog circuits with ”switch” components, such as diodes. A ”switch” component is an electrical device that may ormay not conduct, depending on the state of the circu
Report to the Minister of Justice and Attorney General Public Fatality Inquiry WHEREAS a Public Inquiry was held at the Date and Time of Death: Royal Alexandra Hospital, Edmonton, Alberta Medical Cause of Death: (“cause of death” means the medical cause of death according to the International Statistical Classification of Diseases, Injuries and Causes of Death as last r