Basic Homecare Full-Electric Bed **Requires Prior Authorization
Self-Adjusting Air/Foam Mattress with Optional Alternating Pressure Pump. **Requires Prior Auth (can be used on your existing bed or the full electric bed)
**Requires Prior Authorization
Limit 1 per year
Limit 1 per year.
Limit 1 per year. **Requires Prior Auth
**Requires Prior Auth
*requires prior authorization
Mobility to sit to stand device for transferring from Bed, Seat & Wheelchair **Requires Prior Auth
Limit 3 packages per month of either Alcohol Surface Wipes, Alcohol Prep Pads, or both. (brandnames may differ)
Limit 3 packages per month of either Alcohol Surface Wipes, Alcohol Prep Pads, or both.
Limit 1 thermometer per year
Limit 3 per month
Limit 9 per 6 months (12 total per year)
*Requires Prior Authorization
More than 300 continence items per month will require a script. This total includes all wearable incontinence items such as insert pads, pull up briefs, and tabbed briefs.
Skin Protectant
Removable back and arms
Include Mounting Hardware
More than 3 grab bars requires a script. This total includes Suctionand Screw in bars.