Clinical Guideline
  • Lower Limb Orthotics

    This section addresses therapeutic shoes, inserts, and modifications to therapeutic shoes for individuals with diabetes.
    Therapeutic shoes may be custom-molded or depth shoes. This section also addresses orthopedic footwear including shoes,
    inserts and modification to shoes for individuals who do not have diabetes.

  • Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lu

    This section addresses the use of back braces that are designed to immobilize or support various levels of the spine to treat back conditions.

  • Wheeled Mobility Devices: Manual Wheelchairs– Sta

    This section addresses the criteria for standard, heavy duty and lightweight manual wheelchairs.

  • Pressure Reducing Support Surfaces

    This section addresses the use of pressure reducing support surfaces. A pressure reducing support surface is designed
    to prevent or promote the healing of certain types of pressure ulcers by reducing or eliminating tissue interface pressure.

  • Hospital Beds and Accessories

    Hospital beds are specialized beds used primarily in the treatment of individuals with an illness or injury. Hospital bed
    accessories are durable medical equipment items used in conjunction with a hospital bed.

  • Lower Limb Prosthesis

    This section addresses the use of lower limb prostheses required to replace the function of a lower limb loss due
    to trauma, disease or a congenital condition.

  • Home Oxygen Therapy

    Home oxygen therapy is the home administration of oxygen at concentrations greater than the ambient air with the intention
    of treating or preventing the symptoms and manifestations of hypoxemic or non-hypoxemic medical conditions that are known
    to clinically improve with oxygen.

  • Seat Lift Mechanisms

    This document addresses patient lifts,and Seat lift. Seat lift mechanisms are assistive devices used to lift the body from
    a sitting position to a standing position. The seat lift mechanism is also capable of lowering the individual from a standing to a sitting position.
    A patient lift is a device used to assist the caregiver(s) in transferring an individual from bed to chair and back
    or other locations when the individual is unable to assist with the transfer.

  • External Infusion Pumps

    This sections/documents addresses the use of external infusion pumps in the home or residence setting for diagnoses other than diabetes or pulmonary hypertension.

  • Canes and Crutches
  • Upper Limb Orthotics

    Upper extremity orthoses are devices applied externally to restore or improve functional and structural characteristics of the musculoskeletal and nervous systems.[1] In general, musculoskeletal problems include those resulting from trauma, sports, and work-related injuries.

  • Arthritis