Medical Supplies and Equipment Benefit Lists

8.0 Respiratory equipment and supplies benefits list:

For information on policies regarding the provision of respiratory equipment and supplies, please consult the Guide for Medical Supplies and Equipment.

Respiratory equipment and supplies benefits list

List terminology

Item description:
Items are listed within general and specific categories (for example: Audiology), in alphabetical order by category and item.
Item code:
The 8-digit code that must be submitted to ESI Canada for billing purposes.
Prior approval:
Identifies by general category, or by item within the category, whether prior approval must be obtained by the provider before dispensing the item.
Recommended replacement guidelines:
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.
Prescriber type:

INT – Internal medicine specialist
MD  – Physician
NP – Nurse Practitioner
RESP – Respirologist
RN  – Registered Nurse
(RN renewals only) – Registered Nurse (initial prescription required from MD, NP, NSWOC, WOCC(C))
SLP – Speech-language pathologist
SM – Sleep Medicine Physician

Provider type:
GEN – Enrolled general MS&E and pharmacy provider
RP – Enrolled respiratory provider with appropriate health care staff including regulatory affiliations:
  • RRT – Registered Respiratory Therapist
  • RN – Registered Nurse trained in managing respiratory conditions
Maximum price:
The NIHB Program has established a maximum price coverage for certain items. The maximum national prices are shown in the tables below (please note that in some cases a price grid has been established for the provinces and one for the territories). The maximum prices for each province and territory are listed on the Express Script Canada website and can be viewed by clicking on the appropriate link in the benefit listings.

When a maximum price is established by the Program, the provider cannot claim a markup on the reimbursement request since it is included in the price.

8.1 Breathing apparatus and supplies

Item Description Item Code Prior Approval Recommended Replacement Guidelines Maximum Price Prescriber Provider
Auto CPAP (APAP), purchase 99401084 Yes 1 every 5 years Price File INT, MD, NP, RESP, SM RP
Auto CPAP (APAP), rental 99401083 Yes Up to 3 months Price File INT, MD, NP, RESP, SM RP
BPAP S (bilevel, standard), purchase 99400211 Yes 1 every 5 years Price File INT, MD, NP, RESP, SM RP
BPAP S (bilevel, standard), rental 99400210 Yes Up to 3 months Price File INT, MD, NP, RESP, SM RP
BPAP ST (with backup rate), purchase 99400851 Yes 1 every 5 years   INT, MD, RESP, SM RP
BPAP ST (with backup rate), rental 99400850 Yes Up to 3 month   INT, MD, RESP, SM RP
CPAP (fixed), purchase 99400175 Yes 1 every 5 years Price File INT, MD, NP, RESP, SM RP
CPAP (fixed), rental 99400174 Yes Up to 3 months Price File INT, MD, NP, RESP, SM RP
Inlet filters 99400176 No 12 per year Price File Initial request only INT, MD, NP, RESP, SM RP
Interface with headgear, nasal 99401220 Yes 2 per year Price File Initial request only INT, MD, NP, RESP, SM RP
Interface with headgear, nasal pillows system 99401222 Yes 2 per year Price File Initial request only INT, MD, NP, RESP, SM RP
Interface with headgear, full face 99401202 Yes 2 per year Price File Initial request only INT, MD, NP, RESP, SM RP
Nasal pillows for headgear 99400848 Yes 2 per year Price File Initial request only INT, MD, NP, RESP, SM RP
CPAP, chin strap 99401152 Yes 2 per year Price File Initial request only INT, MD, NP, RESP, SM RP
CPAP/Bilevel tubing, standard 99401221 Yes 2 per year Price File Initial request only INT, MD, NP, RESP, SM RP

8.2 Respiratory secretion clearance

Item Description Item Code Prior Approval Recommended Replacement Guidelines Prescriber Provider
Suction catheters, disposable 99400185 Yes 2000 per year MD, NP, (RN renewals only) GEN
Suction machine, purchase 99400187 Yes 1 every 5 years INT, MD, NP, RESP GEN
Suction machine, rental 99400186 Yes   INT, MD, NP, RESP GEN
Tubing and collection bottle 99400188 No 26 per year MD, NP, (RN renewals only) GEN
Yankeur-tonsil suction 99400189 No 26 per year MD, NP, (RN renewals only) GEN

8.3 Tracheotomy supplies and equipment

Item Description Item Code Prior Approval Recommended Replacement Guidelines Maximum Price Prescriber Provider
Distilled water (for tracheostomy care) 99400626 No 4L containers/55 units per year   MD, NP, (RN renewals only), SLP GEN
Heat & Moisture Exchanger (HME) standard 99401232 No 1 per day $3.92 MD, NP, SLP GEN
Heat & Moisture
Exchanger (HME) specialized
99401233 No 1 per day $10.15 MD, NP, SLP GEN
Heat & Moisture Exchanger (HME) Housing/baseplate standard 99401234 No 1 per day $3.80 MD, NP, SLP GEN
Heat & Moisture Exchanger (HME) Housing/baseplate specialized 99401235 No 1 per day $6.90 MD, NP, SLP GEN
Hydrogen Peroxide 99400197 No 72 bottles per year   MD, NP, RN, SLP GEN
Pipe cleaners 99400198 No 240 per year   MD, NP, RN, SLP GEN
Respiratory equipment, Repairs 99400195 Yes       GEN
Speaking valves 99400193 Yes 4 per year $200 MD, NP, SLP GEN
Tracheostomy brush 99400201 No 6 per year   MD, NP, (RN renewals only), SLP GEN
Tracheostomy drain sponge 99400200 No 800 per year   MD, NP, RN, SLP GEN
Tracheostomy mask (Disposables included in the price of oxygen rental equipment) 99400627 No 24 per year   MD, NP, (RN renewals only) GEN
Tracheostomy ties 99400178 No 2 rolls per year   MD, NP, (RN renewals only), SLP GEN
Tracheostomy tubes 99400194 Yes 24 per year   MD, NP, SLP GEN
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