• Automatic External Defibrillator - Non-Wearable [PDF]
• Automatic External Defibrillator - Wearable [PDF]

• Continuous Glucose Monitors [PDF]
• Glucose Monitors and Related Supplies [PDF]
• Therapeutic Shoes for Persons with Diabetes [PDF]

• Immunosuppressive Drugs [PDF]
• Oral Anticancer Drugs [PDF]

• Hospital Beds [PDF]
• Hospital Bed Accessories [PDF]

• Canes and Crutches [PDF]
• Custom Manual Wheelchair [PDF]
• Heavy Duty Wheelchairs [PDF]
• Lightweight Wheelchairs [PDF]
• Power Operated Vehicles (POV) [PDF]
• Power Wheelchairs [PDF]
• Push Rim Activated Power Assist Device [PDF]
• Standard Hemi-Wheelchair [PDF]
• Standard Wheelchair [PDF]
• Tilt-In-Space Wheelchairs [PDF]
• Transport Chairs [PDF]
• Walkers [PDF]

• Negative Pressure Wound Therapy - Continuous Coverage [PDF]
• Negative Pressure Wound Therapy - Home Setting [PDF]
• Negative Pressure Wound Therapy - In Patient Setting [PDF]

• Enteral Nutrition [PDF]
• Parenteral Nutrition [PDF]

• Face-to-Face Evaluation [PDF]
• Standard Written Orders [PDF]

• AFO KAFO Custom Fabricated [PDF]
• Knee Orthoses - Custom Fabricated [PDF]
• Knee Orthoses - Prefabricated [PDF]
• Spinal Orthoses [PDF]

Osteogenesis

• Osteogenesis Stimulators [PDF]

• Ostomy Supplies [PDF]

• Multi-Positional Patient Lifts [PDF]
• Patient Lifts [PDF]

• External Breast Prostheses [PDF]
• Lower Limb Prothesis - Initial [PDF]
• Lower Limb Prosthesis - Replacement [PDF]

• Refractive Lenses [PDF]

• Central Sleep Apnea or Complex Sleep Apnea [PDF]
• Continued RAD Therapy [PDF]
• High Liter Flow Oxygen - Greater than 4 LPM [PDF]
• Hypoventilation Syndrome - RAD with a Backup Rate Feature [PDF]
• Hypoventilation Syndrome - RAD without a Backup Rate Feature [PDF]
• Nebulizers [PDF]
• Positive Airway Pressure (PAP) [PDF]
• Respiratory Assist Device (RAD) [PDF]
• Severe COPD - RAD with a Backup Rate Feature [PDF]
• Severe COPD - RAD without a Backup Rate Feature [PDF]
• Ventilators [PDF]

• Suction Pumps [PDF]

• Pressure Reducing Support Surfaces - Group 1 [PDF]
• Pressure Reducing Support Surfaces - Group 2 [PDF]
• Pressure Reducing Support Surfaces - Group 3 - Continued Coverage [PDF]

• Surgical Dressings [PDF]

• Transcutaneous Electrical Nerve Stimulators (TENS) [PDF]
• Transcutaneous Electrical Nerve Stimulators (TENS) Conductive Garment [PDF]

• Therapeutic Shoes for Persons with Diabetes [PDF]

• Tracheostomy Care Supplies [PDF]

• Urological Supplies [PDF]