Alberta Aids to Daily Living Manual X - Seating and Wheelchair … · Occasional wheelchair users...

Alberta Health

AADL Approved Product List Seating Benefits and Wheelchair Accessories

Pricing effective May 1, 2018Revised September 25, 2020

Table of Contents

Approved Manufacturers 2

Wheelchair Cushions 3

Wheelchair Backrests 8Head Supports 12Upper Extremity Supports 13Thoracic Supports 15Pelvic Supports 16Lower Extremity Supports 17Wheelchair Accessories 19Other Postural Support Devices 21Maintenance & Repairs 22

Alberta Health - Pharmaceutical and Supplementary BenefitsAlberta Aids to Daily Living Manual X - Seating and Wheelchair Accessories Approved Product List

APL X-1© 2020 Government of Alberta Revised September 25, 2020

Approved Seating Manufacturers

5 Minds Mobility Jonathan Alexander [email protected]

Blake Medical Mike Dangerfield [email protected]

Bodypoint Jonathan Alexander [email protected]

Daher Manufacturing Inc Durga Liske [email protected]

Drive Medical Canada Rebecca Schmalz [email protected]

Essential Medical Products Nils Findlay [email protected]

Future Mobility Healthcare Katelynn Van Engelen [email protected]

Innovators 1993 Gordon White [email protected]

Invacare Tom Corbett [email protected]

Maple Leaf Healthcare Rick Mohan [email protected]

Maple Leaf Wheelchair Dale Sherriff [email protected]

Nighthawk Manufacturing Jason Fakeley [email protected]

nxt Brandon Strap [email protected]

Ottobock Craig Royal [email protected]

Physipro Corrinne Carriere [email protected]

Power Plus Mobility Mike Dangerfield [email protected]

Pride Mobility Products Mike Nantais [email protected]

Ride Designs Craig Royal [email protected]

ROHO Jonathan Alexander [email protected]

Star Cushion Products, Inc. Any Woodcock [email protected]

Stealth Mike Nantais [email protected]

Sunrise Medical Jessica Mueller [email protected]

Symmetric Designs Jeff Jones [email protected]

Therafin Nils Findlay [email protected]

Varilite Braden Hirsch [email protected]

Vicair Brandon Strap [email protected]

Nils Findlay [email protected]


APL X-2

and Contact Information

Ki Mobility Axiom Seating Nils Findlay [email protected]

Western Home Medical

© 2020 Government of Alberta Revised September 25, 2020

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Wheelchair Cushions

All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.

Cushions

Part-time wheelchair users are only eligible for V985

Occasional wheelchair users are only eligible for V990 (No Seating Assessment required)

Cat. No. Max. PriceQty./Freq.Seating Level

Wheelchair Cushion for Occasional User

A V990Sizes up to 20" x 20" $110.00 Each1 Cushion Per 3 Years

No Seating Assessment required

Wheelchair Cushion for Level A Seating

Needs

A V985Part-Time User, Sizes up to 20" x 20" $350.00 Each1 Cushion Per 3 Years

A V980Full-Time User, Sizes up to 20" x 20" $589.00 Each1 Cushion Per 3 Years

For V980 - Clients must be offered a choice of cushions that includes foam cushions and air immmersion cushions, without an upgrade cost.

"Air immersion cushion" is defined as a cushion that has a support surface with segmented air cells which allows for immersion of the body in order to provide pressure redistribution.

Wheelchair Cushion for Level B Seating

Needs

B N570Adjustable Positioning, Sizes up to 20" x 20" $719.00 Each1 Cushion Per 3 Years

"Adjustable positioning" means that the shape of the cushion can easily be adjusted to meet the client's positioning needs.

For N570 - Clients must be offered a choice of cushions that includes foam cushions and air immmersioncushions, without an upgrade cost.

"Air immersion cushion" is defined as a cushion that has a support surface with segmented air cells which allows for immersion of the body in order to provide pressure redistribution.

Wheelchair Cushion for Level C Seating

Needs

C N820Complex Cushion, Sizes up to 20" x 20" $910.00 Each1 Complex Cushion Per 3 Years

"Complex" means that the cushion is designed with aggressive contours to address significant postural issues.Cushion may be pre-contoured or custom-configured (built to a custom shape and size).Cushion may be commerically manufactured or custom-made.Price includes all hardware.

C N830Custom-Configured for Growth, All Sizes $1376.00 Each1 Complex Cushion Per 3 Years

A custom built cushion, may be commercially manufactured or custom-made. Build to a custom ordered size andshape with ability to accommodate growth.Price includes all hardware.

C N840Custom-Contoured Foam, All Sizes $2191.00 Each1 Complex Cushion Per 3 Years

A custom built cushion, may be commercially manufactured or custom-made. Shape is customized to the exact anatomic contours of a specific client (e.g., shape-captured, foam-in-place).Price includes all hardware.


APL X-3


Wheelchair Cushions


Cushions

Part-time wheelchair users are only eligible for V985

Occasional wheelchair users are only eligible for V990 (No Seating Assessment required)


Wheelchair Cushion for Level C Seating

Needs

C N850Custom-Contoured Polypropylene Composite (or equivalent)All Sizes

$2300.00 Each1 Complex Cushion Per 3 Years

Criteria: Client must be able to independently self-propel wheelchair for both indoors and community.

A custom built cushion, may be commercially manufactured or custom-made. Shape is customized to the exact anatomic contours of a specific client (e.g., shape-captured).Price includes all hardware.

Options for Wheelchair Cushions


Oversized / Heavy Duty Option for

Wheelchair Cushions

A V529Size > 20" or Weight Capacity ≥ 350lbs $190.00 Each1 Cushion Option Per Cushion

Combine this catalogue number with the appropriate cushion catalogue number. Price is the maximum, thevendor must bill retail price. This catalogue number cannot be used to reduce upgrade costs.

Incontinence Cover

A V006All Sizes $135.00 Each1 Cushion Cover Per 12 Months

For clients with unmanaged incontinence.

Occasional wheelchair users are NOT eligible.

Postural Support Accessories for Cushions



Lateral Thigh Support

A V864Adductor Added to Cushion - All Sizes $17.50 Each3 Seating Accessories Per 3 Years

Obliquity Pad/Build-up/Fluid Supplement

A V860All Sizes $51.30 Each3 Seating Accessories Per 3 Years

Wedge

A V861Full Wedge $127.30 Each3 Seating Accessories Per 3 Years


APL X-4


Wheelchair Cushions


Postural Support Accessories for Cushions



Wedge

A V862Hemi Wedge $49.40 Each3 Seating Accessories Per 3 Years

Medial Thigh Support

A V863Abductor Added to Cushion - All Sizes $35.00 Each3 Seating Accessories Per 3 Years

Lateral Pelvic Support

A V865Hip Guide Added to Cushion - All Sizes $17.50 Each3 Seating Accessories Per 3 Years


APL X-5


Wheelchair Cushions


Early Replacement Cushions

Early Replacement Cushion catalogue numbers may be used to provide a replacement cushion to a client who has experienced a significant change in clinical condition.

To confirm previous consumption of an Early Replacement Cushion on the IVR or E-Business use one ofthe catalogue numbers listed below. Early Replacement Cushion catalogue numbers do not compete with other cushion catalogue numbers.

Note: Occasional and Part-time wheelchair users are NOT eligible for early replacement cushions.

Eligible reasons for early replacement:

Due to Size ChangeClient must meet the following criteria:

• Must have had the current cushion for at least 1 year.• Must be a change of at least 2 inches in the client's anatomic measurements, or if client exceeds weightcapacity of current cushion.

The authorizer MUST indicate the change in anatomic measurements or weight on the 1250/Authorization.

Due to Skin Integrity IssuesClient must meet the following criteria:

• Must have had pressure wound at least Stage II.• Must have had the current cushion for at least 1 year.

The authorizer MUST indicate the following on the 1250/Authorization:• Stage and location of wound(s).• Indicate other wound prevention strategies that have been implemented.

Due to Significant Change in Functional StatusClient must meet the following criteria:

• Must have had the current cushion for at least 6 months.• Must have progressed from occassional/part-time wheelchair user to full-time wheelchair user.

The authorizer MUST indicate the change of functional status on the 1250/Authorization.


Adult Early Replacement Cushion

A V551Wheelchair Cushion for Level A Seating Needs

$589.00 Each1 Early Replacement Cushion Per Lifetime

MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.

B N559Wheelchair Cushion for Level B Seating Needs



C N857Wheelchair Cushion for Level C Seating Needs




APL X-6

© 2019 Government of Alberta Revised June 19, 2019


Wheelchair Cushions


Early Replacement Cushions

Early Replacement Cushion catalogue numbers may be used to provide a replacement cushion to a client who has experienced a significant change in clinical condition.

To confirm previous consumption of a Early Replacement Cushion on the IVR or E-Business use one of the catalogue numbers listed below. Early Replacement Cushion catalogue numbers do not compete with other cushion catalogue numbers.

Note: Occasional and Part-time wheelchair users are NOT eligible for early replacement cushions.



• Must have had the current cushion for at least 1 year.• Must be a change of at least 2 inches in the client's anatomic measurements, or if client exceeds weightcapacity of current cushion.



• Must have had pressure wound at least Stage II.• Must have had the current cushion for at least 1 year.

The authorizer MUST indicate the following on the 1250/Authorization:• Stage and location of wound(s).• Indicate other wound prevention strategies that have been implemented.

Due to Significant Change in Functional StatusClient must meet the following criteria:

• Must have had the current cushion for at least 6 months.• Must have progressed from occassional/part-time wheelchair user to full-time wheelchair user.

The authorizer MUST indicate the change of functional status on the 1250/Authorization.


Pediatric Early Replacement Cushion

A V550Wheelchair Cushion for Level A Seating Needs

$589.00 Each1 Early Replacement Cushion Per 3 Years


B N555Wheelchair Cushion for Level B Seating Needs



C N852Wheelchair Cushion for Level C Seating Needs




APL X-7

© 2020 Government of Alberta Revised September 25, 2020Classification: Public

© 2020 Government of AlbertaRevised September 25, 2020Classification: Public


Wheelchair Backrests


Backrests

Part-time wheelchair users are only eligible for V495.


Prices listed include hardware.


Backrest for Level A Seating Needs

A V495Keyhole, K-back, or Rigid $350.00 Each1 Backrest Per 3 Years

Part-time or full-time wheelchair user. Not for regular adjustable back upholstery.

Backrest for Level B Seating Needs

B N590Pre-contoured,Sizes up to 20" Wide x 20" Tall,≤3 " Contour Depth

$690.00 Each1 Backrest Per 3 Years

B N593Pre-contoured,Sizes up to 20" Wide x 20" Tall,>3"- 6" Contour Depth


Backrest for Level C Seating Needs

C N891Pre-contoured,Sizes up to 20" Wide x 20" Tall,≥ 6" Contour Depth


C N892Pre-Contoured, With Specialized Positioning, Sizes up to 20" Wide


Specialized features include bi/multi-angular, grid back, air immersion back.

C N894Custom-Configured, All Sizes $1000.00 Each1 Complex Backrest Per 3 Years

A custom built backrest, may be commercially manufactured or custom-made.Built to a custom ordered size and shape.

C N896Custom-Configured for Growth, All Sizes $1301.00 Each1 Complex Backrest Per 3 Years

A custom built backrest, may be commercially manufacutred or custom-made.Built to a custom ordered size and shape with the ability to accommodate growth.

C N898Custom-Contoured Foam, All Sizes $2191.00 Each1 Complex Backrest Per 3 Years

A custom built backrest, may be commercially manufactured or custom-made.Shape is customized to the exact anatomic contours of a specific client (e.g., shape-captured, foam-in-place).

C N899Custom-Contoured Polypropylene Composite (or equivalent)All Sizes

$2900.00 Each1 Complex Backrest Per 3 Years

Criteria: Client must be able to independently self-propel wheelchair for both indoors and community.

A custom built backrest, may be commercially manufactured or custom-made. Shape is customized to the exact anatomic contours of a specific client (e.g., shape-captured).


APL X-8




Options for Backrests


Oversized / Heavy Duty Option for Backrests

B N500Size > 20" Wide or Weight Capacity > 300lbs

$300.00 Each1 Backrest Option Per Backrest

Combine this catalogue number with the appropriate backrest catalogue number. Price is a maximum, the vendor must bill retail price. This catalogue number cannot be used to reduce upgrade costs.

Postural Support Accessories for Backrests



Spinal Alignment Accessories

A V853Large/Small Lumbar $48.45 Each3 Seating Accessories Per 3 Years

A V854Lateral Shim $48.45 Each3 Seating Accessories Per 3 Years

A V855Post/Lateral Pelvic $48.45 Each3 Seating Accessories Per 3 Years

A V856Wedge $48.45 Each3 Seating Accessories Per 3 Years

Gel Insert

A V901Thoracic Area $69.00 Each3 Seating Accessories Per 3 Years

A V902Full Spinal Area $103.50 Each3 Seating Accessories Per 3 Years

A V903Full Back $137.08 Each3 Seating Accessories Per 3 Years


APL X-9




Early Replacement Backrests

Early Replacement Backrest catalogue numbers may be used to provide a replacement backrest to a client who has experienced a significant change in clinical condition.

To confirm previous consumption of an Early Replacement Backrest on the IVR or E-Business use one ofthe catalogue numbers listed below. Early Replacement Backrest catalogue numbers do not compete with other backrest catalogue numbers.

Note: Occasional and Part-time wheelchair users are NOT eligible for early replacement backrests.



• Must have had the current backrest for at least 1 year.• Must be a change of at least 2 inches in the client's anatomic measurements, or if client exceeds weightcapacity of current backrest.



• Must have had pressure wound at least Stage II.• Must have had the current backrest for at least 1 year.

Document the following on 1250 form:• Stage and location of wound(s).• Indicate other wound prevention strategies that have been implemented.


Adult Replacement Backrest

ABackrest for Level A Seating Needs 1 Replacement Backrest V870 $350.00 EachPer Lifetime


B N572Backrest for Level B Seating Needs $790.00 Each1 Early Replacement Backrest Per Lifetime


C N874Backrest for Level C Seating Needs $1301.00 Each1 Early Replacement Backrest Per Lifetime


Pediatric Replacement Backrest

ABackrest for Level A Seating Needs 1 Replacement Backrest V871 $350.00 EachPer 3 Years


B N573Backrest for Level B Seating Needs $790.00 Each1 Early Replacement Backrest Per 3 Years



APL X-10





Early Replacement Backrests

Early Replacement Backrest catalogue numbers may be used to provide a replacement backrest to a client who has experienced a significant change in clinical condition.

To confirm previous consumption of a Early Replacement Backrest on the IVR or E-Business use one of the catalogue numbers listed below. Early Replacement Backrest catalogue numbers do not compete with other backrest catalogue numbers.

Note: Occasional and Part-time wheelchair users are NOT eligible for early replacement backrests.



• Must have had the current backrest for at least 1 year.• Must be a change of at least 2 inches in the client's anatomic measurements, or if client exceeds weightcapacity of current backrest.



• Must have had pressure wound at least Stage II.• Must have had the current backrest for at least 1 year.

Document the following on 1250 form:• Stage and location of wound(s).• Indicate other wound prevention strategies that have been implemented.


Pediatric Early Replacement Backrest

C N875Backrest for Level C Seating Needs $1301.00 Each1 Early Replacement Backrest Per 3 Years



APL X-11


Head Supports


Head Support Pads



Headrest/Neckrest Pad

A V081Standard Pad $190.00 Each1 Headrest Pad Per 3 Years

B N582Headrest with Lateral Support $255.00 Each1 Headrest Pad Per 3 Years

C N883Headrest with Lateral Support and Movable Lateral Extension

$511.43 Each1 Headrest Pad Per 3 Years

C N885Custom-Contoured $428.78 Each1 Headrest Pad Per 3 Years

C N887Headrest with Anterior Trunk Support $540.00 Each1 Headrest Pad Per 3 Years

Head Support Hardware



Hardware for Headrest/Neckrest

A V338Standard Straight $165.00 Each1 Headrest Hardware Per 3 Years

B N533Multi-Axis Hardware $200.00 Each1 Headrest Hardware Per 3 Years

B N535Link or Goose Neck Style Multi-Axis $280.00 Each1 Headrest Hardware Per 3 Years

C N832Multi-Axis Flip Back $380.00 Each1 Headrest Hardware Per 3 Years

Options for Head Supports



Adaptor Kit or Mounting Plate

A V085All Types $189.70 Each1 Adaptor Kit or Mounting Plate Per 3 Years

Tone Deflector

C N865All Types $265.00 Each1 Tone Deflector Per 3 Years

Head Strap

C N873Halo Strap or Fitted Head Strap $120.72 Each1 Head Strap Per 12 Months


APL X-12


Upper Extremity Supports


Inferior Arm Supports



Arm Strap

C N819Single Strap $96.94 Each4 Upper Ext. Support Straps Per 12 Months

Arm Trough or Channel

A V572Hardware and Pad $182.00 Each1 Arm Support Per Side Per 3 Years

A V574With Swivel Elevating Unit for Arm Trough $432.00 Each1 Arm Support Per Side Per 3 Years

A V577Arm Trough Tray Assembly $432.00 Each1 Arm Trough Per Side Per 3 Years

Modified Armrest

C N866Hardwear and Pad $168.74 Each1 Arm Support Per Side Per 3 Years

Trays


All prices include hardware and tray.


Wheelchair Tray

A V476Standard or Padded, Full or Half, Up to 18" Wide

$257.60 Each1 Arm Support Per 3 Years

A V542Standard or Padded, > 18" Wide $310.20 Each1 Arm Support Per 3 Years

C N851Custom-Made, Padded $510.07 Each1 Arm Support Per 3 Years

C N856Custom-Made for Communication Device $534.79 Each1 Arm Support Per 3 Years

Eligible for a client with Level B seating needs if authorized for a power wheelchair by Level C team.

C N854Custom-Made, Lexan, Added Lip $687.41 Each1 Arm Support Per 3 Years

C N880Custom-Made, Heavy Duty, Lexan $705.11 Each1 Arm Support Per 3 Years

C N881Custom-Made, Heavy Duty Bayonet, Lexan, Added Lip

$862.70 Each1 Arm Support Per 3 Years

Eligible for a client with Level B seating needs if authorized for a power wheelchair by Level C team.


APL X-13




Upper Extremity Supports


Options & Accessories for Trays



Elbow Stops

A V762• Elbow Stop Straight• Elbow Stop Curved• Elbow Stop Curved Extended• Extended Padded Elbow Stops

$90.00 Each1 Posterior Arm Support Per Arm Per 3 Years

C N843Added to Custom-Built Tray $201.85 Each1 Posterior Arm Support Per Arm Per 3 Years

Lateral Support

A V766• Lateral support• Lateral support Extended

$90.00 Each1 Lateral Thoracic Support Per Side Per 3 Years

Hand Block

A V769 $90.00 Each3 Tray Accessories Per 3 Years

Tray Customization

A V710Up to 1 Hour Labour $66.50 Each1 Tray Customization Per 3 Years

Clear Overlay for Speech Board

A V768 $90.00 Each3 Tray Accessories Per 3 Years

Bayonet Mounting on Tray

C N863 $213.15 Each1 Mounting of Tray Per 2 Years

Communication Board Mount to Seating

System

C N860 $312.13 Each1 Mounting of Tray Per 2 Years

Posterior Arm Supports


Shoulder Protraction Wedges

C N841All Sizes $96.94 Each1 Posterior Arm Support Per Arm Per 3 Years


APL X-14


Thoracic Supports


Lateral Thoracic Supports


Lateral Thoracic Support

B N514Fixed Hardware and Pad $235.00 Each1 Lateral Thoracic Support Per Side Per 3 Years

C N849Swing-Away Hardware and Pad $365.00 Each1 Lateral Thoracic Support Per Side Per 3 Years

C N818Integrated Lateral Support $305.00 Each1 Lateral Thoracic Support Per Side Per 3 Years

For Level C backrests with an intergrated lateral support of >6".

Anterior Thoracic Supports


Chest Strap

B N541Single Horizontal Strap $94.00 Each1 Thoracic Support Strap Per 12 Months

B N525Butterfly Strap $193.00 Each1 Thoracic Support Strap Per 12 Months

B N505Waistcoat Style $283.56 Each1 Thoracic Support Strap Per 12 Months

Axilla Strap

C N817Single Strap $96.94 Each1 Axilla Support Per Side Per 12 Months


APL X-15


Pelvic Supports


Lateral Pelvic Supports


Lateral Pelvic Support/Hip Bolster

B N588Hardware and Pad $85.00 Each1 Lateral Pelvic Support Per Side Per 2 Years

C N831Hardware and Pad $210.47 Each1 Lateral Pelvic Support Per Side Per 2 Years

Superior Pelvic Supports


Pelvic Strap

B N5272 or 4 Point $165.00 Each1 Pelvic Support Belt Per 12 Months

Sub-ASIS Support

C N805Sub-ASIS Belt $232.00 Each1 Pelvic Support Belt Per 12 Months

C N800Sub-ASIS Bar $417.14 Each1 Pelvic Support Belt Per 12 Months

Inferior Pelvic Supports



Solid Seat Base

A V554Stardard, Up to 18"x18" $94.00 Each1 Base Per 3 Years

A V556Heavy Duty, >18"x18 $143.00 Each1 Base Per 3 Years

C N855Custom Contoured, All Sizes $549.54 Each1 Base Per 3 Years

Drop Base

A V565Stardard, Up to 18"x18" $247.00 Each1 Base Per 3 Years

A V567Heavy Duty, Over 18" Wide $327.75 Each1 Base Per 3 Years

B N564Adjustable, Up to 18" Wide $376.00 Each1 Base Per 3 Years

B N566Adjustable, 18" - 22" Wide $441.00 Each1 Base Per 3 Years

C N862Padded, All Sizes $455.92 Each1 Base Per 3 Years


APL X-16


Lower Extremity Supports


Lateral Thigh/Knee Supports


Abduction Strap

C N868Single Strap $96.94 Each3 Lower Ext. Support Straps Per 12 Months

Lateral Thigh Support/Adductors

B N814Hardware and Pad $150.00 Each1 Lateral Thigh Support Per Leg Per 3 Years

Neoprene Padding of Front Rigging

C N846All Sizes $106.89 Each1 Lateral Thigh Support Per Leg Per 3 Years

Medial Knee Supports


Abductor/Pommel

B N532Non-Removable Hardware and Pad $227.69 Each1 Medial Thigh Support Per 3 Years

B N523Removable Hardware and Pad $410.00 Each1 Medial Thigh Support Per 3 Years

C N877Flip-Down Hardware and Pad $540.00 Each1 Medial Thigh Support Per 3 Years

C N835Custom-Built Flip-Down Hardware and Pad $675.71 Each1 Medial Thigh Support Per 3 Years

Anterior Lower Leg Supports


Knee Block

C N829Hardware and Pads $505.54 Each1 Anterior Knee Support Per 3 Years

Shin Strap

C N821Single Strap $92.63 Each1 Anterior Knee Support Per 3 Years


APL X-17


Lower Extremity Supports


Posterior Lower Leg Supports


Calf Support

A V617Bilateral Calf Strap or H-Strap $80.00 Each3 Lower Ext. Support Straps Per 12 Months

C N861Rigid Support $234.94 Each3 Lower Ext. Support Straps Per 12 Months

Foot & Ankle Supports


Footstrap/Toe Loop

B N554Single Strap $31.00 Each3 Lower Ext. Support Straps Per 12 Months

Heel Loop/Ankle Strap

B N507Single Strap $92.63 Each3 Lower Ext. Support Straps Per 12 Months

B N571Ankle Hugger Style $187.00 Pair3 Lower Ext. Support Straps Per 12 Months

Modified Foot Support

A V619• Footbox/Foot Pocket• Modified/Adapted Footplate• Shoe Holders• Padded Footrests or Footboards

$179.55 Each1 Foot Support Per Foot Per 2 Years

Price represents cost for one side/foot. 1 footboard = quantity of 2, or 1 shoe holder = quantity of 1

Amputation Boards & Pads

No Seating Assessment required


Amputee Board

A V581Standard, Up to 20" Wide $350.00 Each1 Base Per 3 Years

A V583Heavy Duty or Angle Board, Up to 28" x 22" $412.50 Each1 Base Per 3 Years

For clients who require weight capacity >250lbs or with bilateral amputations.

A V585Drop Seat Style, Up tp 22" x 18" $440.88 Each1 Base Per 3 Years

Pad for Amputee Board

A V579All Sizes $62.50 Each1 Amp. Pad Per Limb Per 2 Years


APL X-18



Wheelchair Accessories


Hardware


Clips or Hooks

B N537Standard Hooks $14.90 Each8 Clips or Hooks Per 3 Years

B N534Drop Base Mount Clips $26.30 Each8 Clips or Hooks Per 3 Years

B N538Locking Suspension Hook $34.63 Each8 Clips or Hooks Per 3 Years

Seat-to-Back Bracket

B N502Sliding 90 Degree Bracket $46.07 Each1 Seat-to-Back Bracket Per 3 Years

B N508Growth Bracket/Hardware $60.08 Each1 Seat-to-Back Bracket Per 3 Years

Clamp

B N531All Sizes $46.46 Each2 Clamps Per 3 Years

Spacer Hardware

B N510All Sizes $215.65 Per Pair

1 Pair of Space Hardware Per 3 Years

2nd Set Backrest Hardware

B N551Standard $311.00 Per Pair

1 2nd Back Hardware Per 3 Years

To transfer to a second wheelchair.

B N552Heavy Duty $381.90 Per Pair

1 2nd Back Hardware Per 3 Years

To transfer to a second wheelchair.

Hardware Kit for Belt or Strap

B N504All Sizes $24.70 Each1 Strap Hardware Kit Per 12 Months

Safety Strap

C N844Single Strap $103.00 Each1 Safety Strap Per 2 Years

To secure insert to mobility base

Postural Support Hardware Not-Listed

C N836All Sizes $150.00 Each1 Misc. Hardware Per Side Per 3 Years

To be used in cases where there is a clinically assessed need for specific hardware that is not otherwise listed in the approved product list. This catalogue cannot be used to reduce upgrade costs or provide duplicate benefits. Utilization of this catalogue number will be closely monitored by AADL.


APL X-19


Wheelchair Accessories


Options for Belts or Straps


Padded Option for Strap

C N879Padding for single strap $120.69 Each4 Padded Options Per 12 Months

For custom-made straps only. Not eligible for commercially available straps.


APL X-20


Other Postural Support Devices


Custom Inserts


Custom-Made Commode Insert

C X047Includes: Back, Laterals, Footstraps, Chest Straps

Prior Approval1 Commode Insert Per 4 Years

Must be custom-made components only. Not eligible if off-the-shelf components can provide appropriate postural support. AADL does not fund pelvic straps for commodes.

Custom-Made Stroller Insert

B X636Includes: Head Support, Foam, Covering and Pelvic Strap

$1102.20 Each1 Stroller Insert Per 2 Years

Must be custom-made components only. Not eligible if off-the-shelf components can provide appropriate postural support.

Floor Sitter


GRIP Seat

B X474 $172.00 Each1 Floor Sitter Per 2 Years


APL X-21


Maintenance & Repairs


Replacement Components


No Seating Assessment required. Clinical justification and explanation must be clearly indicated on the 1250 or E-business benefit note.


Replacement Cover for Wheelchair Cushion

A V101Level A or B Cushion Cover - All Sizes $165.00 Each1 Cushion Cover Per 12 Months

C N801Level C Pre-Contoured Cushion Cover - All Sizes

$190.00 Each1 Cushion Cover Per 12 Months

C N806Level C Custom-Contoured Cushion Cover - All Sizes

$300.00 Each1 Cushion Cover Per 12 Months

Replacement Cover for Backrest

A V571Level A or B Backrest Cover - All Sizes $183.00 Each1 Backrest Cover Per 12 Months

C N869Level C Backrest Cover - All Sizes $333.45 Each1 Backrest Cover Per 12 Months

Replacement Foam for Backrest

B N513All Sizes $130.00 Each1 Replacement Backrest Foam Per 3 Years

Current foam must be outside of warranty (minimum 6 months).Ensure the current backrest will continue to meet the client's long term needs. The client is not eligible for a replacement backrest for 2 years after the replacement foam is provided.

Replacement Hardware for Backrest

B N567Standard $311.00 Per Pair

1 Replacement Backrest Hardware Per 3 Years

Current hardware must be outside of warranty (minimum 2 years).Ensure the current backrest will continue to meet the client's long term needs. The client will not be elibigle for a new backrest for 2 years after the replacement hardware is provided.

B N569Heavy Duty $381.90 Per Pair

1 Replacement Backrest Hardware Per 3 Years

Current hardware must be outside of warranty (minimum 2 years).Ensure the current backrest will continue to meet the client's long term needs. The client will not be elibigle for a new backrest for 2 years after the replacement hardware is provided.

Replacement Cover for Head Support

A V570All Sizes $120.00 Each1 Headrest Cover Per 12 Months

Replacement Cover for Lateral Thoracic

Support

B N549All Sizes $50.00 Each1 Lateral Cover Per Side Per 12 Months


APL X-22



Maintenance & Repairs


Replacement Components




Replacement Pad for Pediatric Lateral

Thoracic Support

C N847All Sizes $50.00 Each1 Replacement Pad Per 3 Years

May only be authorized due to growth or change in posture for a pediatric client

Modifications

Modification can only be authorized for existing systems, at least 6 months after the service date. Cannot be authorized for newly provided equipment.




Adjustments

A V596Growth of Seating System $67.00 Each3 Modifications Per 12 Months

A V599Adjustment of Postural Supports $35.00 Each3 Modifications Per 12 Months

Transfer System to New Wheelchair

A V594 $67.00 Each3 Modifications Per 12 Months

Eligible when client is provided a new wheelchair and fixed hardware must be transferred. Cannot be used to transfer a cushion only.

Repairs

For Level C seating components only.

Repairs can only be authorized for existing systems, at least 1 year after the service date. Cannot be authorized for newly provided equipment.

No Seating Assessment required. Must provide clinical justification in E-business notes.


Repair to Custom-Made Device

C N842Labour Costs $17.00 Per 15 Min. Interval

8 Labour Units Per 12 Months

C N845Material Costs $20.00 Each8 Material Units Per 12 Months


APL X-23


Alberta Aids to Daily Living Manual X - Seating and Wheelchair … · Occasional wheelchair users...

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Transcript of Alberta Aids to Daily Living Manual X - Seating and Wheelchair … · Occasional wheelchair users...