Alberta Health AADL Approved Products List Respiratory Effective August 1, 2017

Transcription

1 Alberta Health Approved Products List Respiratory Effective Oxygen... APL R-1 BPAP... APL R-2 BPAP Supplies.. APL R-4 Ventilator Supplies... APL R-5 Other Respiratory... APL R-6

2 OXYGEN Definitions: Urban areas are defined as within the municipal boundaries of Edmonton, Calgary, St. Albert, Sherwood Park, Grande Prairie, Lethbridge, Medicine Hat, Red Deer, Airdrie, Camrose, Fort Saskatchewan, Leduc, Lloydminster, Spruce Grove and Wetaskiwin. Rural areas include all other areas of the province. 1. Restart fee must be used if oxygen is restarted within 12 months from the last oxygen authorization expiry date. 2. Per diem rate calculation for R633 and R733 is based on the monthly rate x 12/365. It is used when partial month billing is required. 3. Billing codes for urban and rural rates shall correspond with the client s mailing address. Per Diem Rate R633 Urban Flat Fee 12 per benefit year R733 Rural Flat Fee 12 per benefit year R778 Urban Flat Fee Set Up 1 per benefit year R878 Rural Flat Fee Set Up 1 per benefit year R931 Rural Restart Set Up 1 per benefit year R932 Urban Restart Set Up 1 per benefit year $ $10.88 $ $11.90 $ $ $ $ Government of Alberta APL R-1

3 BPAP 1. Per diem rate calculation is based on the monthly rate x 12/365. It is used when partial month billing is required. 2. For clients whose BPAP was started out on the new service delivery model (and they only have one BPAP), their BPAP supply funding required for the initiation or reinstruction and the ongoing period is covered under the service fee. Per Diem Rate R960 R970 R807 R808 R916 R936 R805 R806 Initiation Period Service Fee for Sleep Disordered Breathing and Other Initiation Period Service Fee for Neuromuscular Disorders and Under 13 years Initiation Period Equipment Fee for BPAP without backup rate Initiation Period Equipment Fee for BPAP with backup rate Ongoing Service Fee for Sleep Disordered Breathing and Other Ongoing Service Fee for Neuromuscular Disorders and Under 13 years Ongoing Equipment Fee for BPAP without backup rate Ongoing Equipment Fee for BPAP with back-up rate 3 per lifetime $ $ per lifetime $ $ per lifetime $51.70 $ per lifetime $88.20 $ per benefit year $68.40 $ per benefit year $ $ per benefit year $25.85 $ per benefit year $44.10 $ Government of Alberta APL R-2

4 BPAP Cont d Per diem rate calculation is based on the monthly rate x 12/365. It is used when partial month billing is required. For clients whose BPAP was started out on the new service delivery model (and they only have one BPAP), their BPAP supply funding required for the initiation or reinstruction service fee and the ongoing BPAP supply funding is covered under the ongoing service fee. Per Diem Rate R770 Reinstruction period Service Fee for Sleep Disordered Breathing and Other 3 per lifetime $ $6.28 R771 Reinstruction Period Service Fee for Neuromuscular Disorders and Under 13 years 3 per lifetime $ $ 7.92 R670 Reinstruction Period Equipment Fee for BPAP without back-up rate 3 per lifetime $51.70 $1.70 R671 Reinstruction Period Equipment Fee for BPAP with back-up rate 3 per lifetime $88.20 $ Government of Alberta APL R-3

5 BPAP Supplies Note: * R213 is for clients who received BPAP funding approval prior to July 1, 2014, now entering into the new BPAP program. The authorization for the interface system (R213) is 12 months from the effective date if the new enrollment and is a one-time payment. Q008 Interface System Fee for 2 nd BPAP 1 per benefit year $ R213 Interface System 12 Month Transition BPAP 1 for the 1 st year $ Q204 Full Face Mask System for BPAP $ Q205 Nasal Pillow System for BPAP 1 per benefit year $ Q206 Nasal Mask System for BPAP $ Q207 Headgear for BPAP 1 per benefit year $38.00 Q208 Chin Strap for BPAP 1 per benefit year $30.00 Q209 Filters for BPAP 12 per benefit year $3.00 Q210 Tubing for BPAP 1 per benefit year $30.00 Q211 Humidifier Chamber for BPAP 1 per benefit year $ Q212 One way Press Valve or O2 Converter BPAP 1 per benefit year $ Government of Alberta APL R-4

6 VENTILATOR SUPPLIES Note: Quantity may increase to 2 per benefit year if clients have 2 ventilators and they are using interface system with their ventilator. Q120 Full Face Mask System for Ventilator $ Q121 Nasal Pillow System for Ventilator 1 per benefit year $ Q122 Nasal Mask System for Ventilator $ Q123 Headgear for Ventilator 1 per benefit year $38.00 Q124 Chin Strap for Ventilator 1 per benefit year $ Government of Alberta APL R-5

7 OTHER RESPIRATORY BENEFITS 1. Benefit year runs from July 1 to June Definitions of urban and rural areas are the same as oxygen; refer to APL R-1. *R260 Standard Tracheostomy Tube In circumstances where shipping from the specialty supplier to the client s residence is required, the provider may charge the client privately for the additional costs. R817 Setup Suction Therapy Rural 1 per 5 years $ R818 Setup Suction Therapy Urban 1 per 5 years $ R400 Non-Portable Suction Unit 1 per 5 years $ R402 Non-Portable Suction Unit (Recycle) 1 per 5 years $44.96 R420 Portable Suction Unit 1 per 5 years $ R422 Portable Suction Unit (Recycle) 1 per 5 years $44.96 R826 Service for Suction Prior Approval 1 per benefit year $ R827 Parts for Suction Prior Approval 1 per benefit year $ R260 Tracheostomy Tube* 13 per benefit year $93.00 R265 Custom Tracheostomy Tube Prior Approval Prior Approval varies 2017 Government of Alberta APL R-7

8 OTHER RESPIRATORY BENEFITS Cont d 1. Benefit year runs from July 1 to June Definitions of urban and rural areas are the same as oxygen; refer to APL R-1. R803 Setup Heavy Duty Compressor (Rural) 1 per 5 years $ R804 Setup Heavy Duty Compressor (Urban) 1 per 5 years $ R340 Heavy Duty Compressor 1 per 5 years $ R342 Heavy Duty Compressor (Recycle) 1 per 5 years $47.24 R837 Service for Heavy Duty Compressor Prior Approval 1 per benefit year $ R838 Parts for Heavy Duty Compressor Prior Approval 1 per benefit year $ R559 Disposable Manual Resuscitator 1 per 5 years $40.00 R846 Pick Up of Respiratory Equipment 3 per benefit year $20.00 R270 Suction Catheter 120 every 2 months As per tendered contract 2017 Government of Alberta APL R-7