Prosthetic & Orthotic Product Identification Numbers (PINs)

The Prosthetic and Orthotic Program helps patients achieve or maintain basic functionality. PharmaCare helps eligible patients pay for the costs of eligible prostheses and orthoses, subject to the rules of their PharmaCare plan, including any annual deductible requirement.
Full details of the Prosthetic and Orthotic Program and associated policies are provided in:

Please note: Health Canada’s Non-Insured Health Benefits (NIHB) covers prosthetic, orthotic, mastectomy, and ostomy benefits for First Nations Health Authority (FNHA) clients. These are not currently covered for FNHA clients under PharmaCare Plan W.

Pre-Approval Requirements

PharmaCare requires pre-approval for all eligible prostheses and orthoses except the following:

  • prosthetic supplies under $400.00
  • lymphedema arm sleeves, and gloves/gauntlets
  • plagiocephaly helmets for patients who meet the criteria set forth on page 2 of the PharmaCare Orthotic Benefits - Plagiocephaly Helmet form (HLTH 5450) (PDF, 529KB)
  • regular benefit breast prostheses (unless requesting an exception to policy, such as replacing a breast prosthesis before the two-year limit; in that case, pre-approval is required)
  • prosthetic and orthotic repairs or adjustments under $400.00

PharmaCare does not cover any non-exempt item unless pre-approval has been granted.

Pre-approval is valid for 6 months from the date on the approval letter returned to the health care provider.

PharmaCare provides coverage for mastectomy prostheses and supplies for eligible individuals who have undergone a mastectomy.

Mastectomy Products PIN Limits
*Breast prosthesis – left 77123116 1 every 2 years; maximum $450
*Breast prosthesis – right 77123104 1 every 2 years; maximum $450
*Breast prosthesis (lumpectomy) – left 77123117 1 every 2 years; maximum $350
*Breast Prosthesis (lumpectomy) – right 77123118 1 every 2 years; maximum $350
Unattached off-the-shelf glove/gauntlet 77123533 2 per year, per mastectomy; maximum $150 each
Unattached custom-fit glove/gauntlet 77123534 2 per year, per mastectomy; maximum $300 each
Lymphedema arm sleeve 77123130 2 sleeves per year, per mastectomy

* Maximum coverage updated June 24, 2015

Claims to PharmaCare should include labour and material costs associated with the device, as included on the pre-approval. These costs should be claimed under the appropriate PIN based on the side that is being fitted.

Prosthetic devices may be replaced:

no sooner than three years from the date on the PharmaCare approval letter/form; and

only if it is demonstrated that the existing device no longer meets the patient’s basic functionality needs.

Ocular PINs
Ocular Products PIN Limits
Ocular polishing/repairs – use ONLY if no pre-approval is required 77123165 Maximum $399.99
Ocular polishing/repairs – use if pre‑approval is required 77123531  
Ocular prosthesis – left 77123153 $2000; extra fitting $2100
Ocular prosthesis – right 77123141 $2000; extra fitting $2100

Claims to PharmaCare should include clinical labour, material and component costs associated with the device, as included on the pre-approval. These costs should be claimed under the appropriate PIN based on the type of orthosis being fitted.

Orthoses for children and youth may be replaced:

  • no sooner than one year from the date on the approval letter; and
  • only if it is demonstrated that the existing device no longer meets the basic functionality needs for the patient.
Orthotic PINs
Orthotic Products PIN Limits
Supramalleolar orthosis  77123507 Maximum $800.00
Ankle foot orthosis – rigid  77123508 Maximum $950.00
Ankle foot orthosis – articulated  77123509 Maximum $1,150.00
Ankle foot orthosis with supramalleolar orthosis – rigid 77123510 Maximum $1,200.00
Ankle foot orthosis with supramalleolar orthosis – articulated 77123537 Maximum $1,400.00
Ankle foot orthosis, patella tendon bearing/ground reaction – rigid 77123511 Maximum $1,200.00
Ankle foot orthosis, patella tendon bearing/ground reaction – articulated 77123536 Maximum $1,400.00
Ankle foot orthosis, anti-crouch/ground reaction – rigid 77123538 Maximum $1,200.00
Ankle foot orthosis, anti-crouch/ground reaction – articulated 77123539 Maximum $1,400.00
Ankle foot orthosis, chevron/double wrap 77123540 Maximum $1,400.00
Hip abduction orthosis, congenital dislocation of hip/hip dysplasia – child brace 77123512  
Hip abduction orthosis, standing/walking/sitting 77123541  
Hip abduction orthosis, legg-calve-perthes disease 77123542  
Knee ankle foot orthosis, knee extension only 77123543 Maximum $1,050.00
Knee ankle foot orthosis, rigid ankle 77123513 Maximum $2,040.00
Knee ankle foot orthosis, articulated ankle  77123514 Maximum $2,240.00
Hip knee ankle foot orthosis 77123515 Maximum $4,000.00
Reciprocating gait orthosis  77123516  
Spinal orthosis, lumbar sacral 77123544 Maximum $1,835.00
Spinal orthosis, thoracic lumbar sacral 77123517 Maximum $2,010.00
Spinal orthosis, cervical thoracic lumbar sacral 77123545 Maximum $2,210.00
Plagiocephaly orthosis – child’s helmet (use when pre-approval IS required) 77123499 Maximum $2,850.00
Plagiocephaly orthosis – child’s helmet (use only when pre-approval is NOT required) 77123535 Maximum $2,850.00
Orthotic repairs and adjustments – use only if NO pre-approval is required 77123504  
Orthotic repairs and adjustments – use if pre‑approval is required 77123528 Maximum $399.99

Claims to PharmaCare should include clinical labour, material and component costs associated with the device, as included on the pre-approval. These costs should be claimed under the appropriate PIN based on the level of amputation, and the side that is being fitted.

Prosthetic devices may be replaced:

  • no sooner than three years from the date on the PharmaCare approval letter/form; and
  • only if it is demonstrated that the existing device no longer meets the patient’s basic functionality needs.
Prosthetic Products PIN Limits
Cosmesis 77123532  
Ear prosthesis – left 77123177 Maximum $4,987.50
Ear prosthesis – right 77123189 Maximum $4,987.50
Elbow disarticulation – left – prosthesis 77123520 Maximum $3,220.00
Elbow disarticulation – right – prosthesis 77123521 Maximum $3,220.00
Hemipelvectomy – left – prosthesis 77123522 Maximum $4,485.00
Hemipelvectomy – right – prosthesis 77123523 Maximum $4,485.00
Hip disarticulation – left – prosthesis 77123440 Maximum $4,370.00
Hip disarticulation – right – prosthesis 77123438 Maximum $4,370.00
Knee disarticulation – left – prosthesis 77123487 Maximum $4,140.00
Knee disarticulation – right – prosthesis 77123475 Maximum $4,140.00
Nose prosthesis 77123501 Maximum $4,987.50
Prosthetic repairs/adjustments – use only if NO pre-approval is required 77123244 Maximum $399.99
Prosthetic repairs/adjustments – use if pre‑approval is required 77123529  
Prosthetic supplies – use only if NO pre-approval is required 77123232 Maximum $399.99
Prosthetic supplies – use if pre‑approval is required 77123530  
Proximal femoral focal deficiency – left – prosthesis 77123524 Maximum $4,200.00
Proximal femoral focal deficiency – right – prosthesis 77123525 Maximum $4,200.00
Rotationplasty – left – prosthesis 77123526 Maximum $3,160.00
Rotationplasty – right – prosthesis 77123527 Maximum $3,160.00
Shoulder disarticulation – left – prosthesis 77123463 Maximum $3,570.00
Shoulder disarticulation – right – prosthesis 77123451 Maximum $3,570.00
Symes prosthesis – left – prosthesis 77123384 Maximum $2,880.00
Symes prosthesis – right – prosthesis 77123372 Maximum $2,880.00
Trans-femoral (above knee) – left – prosthesis 77123359 Maximum $3,740.00
Trans-femoral (above knee) – right – prosthesis 77123335 Maximum $3,740.00
Trans-humeral (above elbow) – left – prosthesis 77123270 Maximum $2,800.00
Trans-humeral (above elbow) – right – prosthesis 77123256 Maximum $2,800.00
Trans-metatarsal – left – prosthesis 77123207  
Trans-metatarsal – right – prosthesis 77123190  
Trans-radial (below elbow) – left – prosthesis 77123281 Maximum $2,300.00
Trans-radial (below elbow) – right – prosthesis 77123268 Maximum $2,300.00
Trans-tibial (below knee) – left – prosthesis 77123360 Maximum $2,760.00
Trans-tibial (below knee) – right – prosthesis 77123347 Maximum $2,760.00
Trans-tarsal – left – prosthesis 77123402 Maximum $1,700.00
Trans-tarsal – right – prosthesis 77123396 Maximum $1,700.00
Wrist disarticulation – left – prosthesis 77123518 Maximum $2,650.00
Wrist disarticulation – right – prosthesis 77123519 Maximum $2,650.00