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 the Prosthetic and Orthotic Policy Manual.

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 HLTH 5450 - PharmaCare Orthotic Benefits: Plagiocephaly Helmet (PDF, 529KB) form
  • 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

Note: Adjudication through PharmaNet does not mean that two years have elapsed. Contacting the Help Desk will ensure that the patient is entitled to the benefit and that the claim adjudicates accurately.

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 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 By approval
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 Products PIN Limits
Supramalleolar orthosis  77123507 Maximum $1,445.00
Ankle foot orthosis – rigid  77123508 Maximum $1,890.00
Ankle foot orthosis – articulated  77123509 Maximum $2,160.00
Ankle foot orthosis with supramalleolar orthosis – rigid 77123510 Maximum $2,160.00
Ankle foot orthosis with supramalleolar orthosis – articulated 77123537 Maximum $2,325.00
Ankle foot orthosis, patella tendon bearing – rigid 77123511 Maximum $3,400.00
Ankle foot orthosis, patella tendon bearing – articulated 77123536 Maximum $4,200.00
Ankle foot orthosis, anti-crouch/ground reaction – rigid 77123538 Maximum $2,200.00
Ankle foot orthosis, anti-crouch/ground reaction – articulated 77123539 Maximum $2,525.00
Ankle foot orthosis, chevron/double wrap 77123540 Maximum $2,300.00
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 $1,900.00
Knee ankle foot orthosis, rigid ankle 77123513 Maximum $4,760.00
Knee ankle foot orthosis, articulated ankle  77123514 Maximum $5,030.00
Hip knee ankle foot orthosis 77123515 By approval
Reciprocating gait orthosis  77123516 By approval
Spinal orthosis, lumbar sacral 77123544 Maximum $1,835.00
Spinal orthosis, thoracic lumbar sacral 77123517 Maximum $2,620.00
Spinal orthosis, cervical thoracic lumbar sacral 77123545 Maximum $3,225.00
Plagiocephaly orthosis – child’s helmet (use when pre-approval IS required) 77123499 Maximum $3,145.00
Plagiocephaly orthosis – child’s helmet (use only when pre-approval is NOT required) 77123535 Maximum $3,145.00
Orthotic repairs and adjustments – use only if NO pre-approval is required 77123504 By approval
Orthotic repairs and adjustments – use if pre‑approval is required 77123528 Maximum $399.99

The ostomy supplies listed below are covered for eligible patients who have undergone bowel and/or bladder surgery that results in a colostomy, ileostomy, or urostomy, requiring an external pouch. Actual reimbursement is subject to the rules of the patient’s PharmaCare plan, including any deductible requirements.

Note: PharmaCare covers certain ostomy supplies for First Nations Health Authority clients under Plan W (see list below). The Non-Insured Health Benefits (NIHB) program may still cover some supplies not eligible under Plan W which may require NIHB prior authorization. 

PIN

Product

Product Examples/Notes*

88123418

Ostomy pouch – drainable

Coloplast Sensura pouch #10471

88123420

Ostomy pouch – closed

Hollister Center Point Lock pouch #3347

88123431

Ostomy pouch – urostomy

Coloplast urostomy pouch #5570

88123443

Stoma caps, colostopads

Hollister #1796

88123455

Ostomy flanges and convex inserts

Coloplast Assura flange #14246

88123467

Colostomy irrigation sets

ConvaTec #1916

88123479

Colostomy irrigation cone, tip, faceplate, sleeves

ConvaTec VisiFlow cone , Hollister sleeves #7728

88123480**

Urostomy night drainage sets

ConvaTec #27060

88123492**

Urostomy tubing and adaptor

ConvaTec Accuseal adaptor

88123510**

Urostomy leg bag and straps

Hollister #9825

88123522

Tape for securing the edges of an ostomy pouch— paper type only

3M paper tape

88123534

Ostomy skin barriers

Eakin seals #83900, Hollihesive skin barriers

88123642

Elastic barrier strips and tape

Coloplast Brava elastic barrier strip, Brava elastic tape straight, Brava elastic tape belt

 88123546

Skin care wipes, sprays and adhesive removers

Hollister skin gel wipes, ConvaTec All Kare  wipes

88123558

Ostomy paste, cement and powder

Stomahesive powder #5507, Hollister Adapt paste #9301

88123560

Ostomy accessories—belt (excluding ostomy support belts), belt rings, closures, filters, and guide strips

Hollister filters #7766, ConvaTec belt #175507

88123571

Ostomy adhesive spray

Hollister 7730

88123583

Tincture of benzoin

-

88123595

Ostomy pouch – reusable style

Marlen Neoprene, Permatype, Torbot

88123625

Faceplates for reusable ostomy pouches (i.e., faceplates for PIN 88123595 above)

Permatype, Marlen

88123637

Internal deodorants (oral tablets)

200mg capsules of bismuth subgallate

*Products in the right-hand column are examples only. Their inclusion is not an endorsement of these products. Coverage is not limited to these products or manufacturers.

**These items are covered only for patients using ostomy pouch – urostomy (PIN 88123431).


Non-benefit items

The following items are not benefits.

  • Catheters—for any use, including
    • for management of any medical or post-surgical condition
    • all products for management of continent urostomies—catheters, absorbent pads
    • Note: PINs 88123480, 88123492 and 88123510 are benefits for patients using a urostomy pouch (PIN 88123431)
  • All products for the management of nephrostomy tubes, feeding tubes, other drainage tubes, wound  drainage—such as Hollister drain tube attachment device, or urinary drainage collection equipment  (including PINs 88123480, 88123492 and 88123510, except as noted above)
  • All products for management of urinary incontinence—catheters, condoms, drainage containment  equipment, diapering systems, incontinence pads, tubing and adapters (including PINs 88123480, 88123492 and 88123510, except as noted above)
  • Cotton covers for pouches or night drainage bottles
  • Pouch liners—such as Colo-Majic
  • Stoma hole cutters
  • Ostomy support belts—such as Nu-Hope
  • Skin protectants—such as Marathon skin protectant
  • Creams—such as Sween Cream, Chiron Cream, BAZA cream
  • Cleansers—such as Uni-Wash, ConvaTec AloeVesta products
  • Lubricants—such as KY Jelly, Hollister stoma lubricant
  • Tapes (other than paper-type or elastic barrier tape)—such as waterproof tape, Elastoplast, straight  transparent dressings—such as OpSite, Tegaderm
  • Room deodorants—such as M9
  • In-pouch deodorants—such as Uri-Kleen, M9, Banish
  • Hydrocolloid dressings—such as DuoDerm, Restore, Tegasorb
  • Instruments—such as scissors, dressings sets
  • Alcohol swabs, sterile and unsterile gauze
  • Any items purchased through online suppliers – items must be purchased from authorized PharmaCare providers.

Note: Exclusion of a product from this list does not imply it is a benefit product.

PharmaCare does not cover any items, even if they are listed in this document, not used for the purposes stated. Non-benefit uses include management of a catheter, diabetes, an insulin pump, wounds, ineligible types of ostomy (e.g., a cecostomy or nephrostomy), feeding tubes, or urinary incontinence.

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, endoskeletal finish—transtibial (TT)
Note: the cosmesis can be billed under a definitive socket PIN, if included in a pre-approval for a full prosthesis; if being billed separately use this PIN
77123532 Maximum $600.00
Cosmesis, endoskeletal finish—transfemoral (TF)
Note: the cosmesis can be billed under a definitive socket PIN, if included in a pre-approval for a full prosthesis; if being billed separately use this PIN
77123532 Maximum $1,380.00 (full cosmesis)
Maximum $600.00 (lower portion only - NEW)
Ear prosthesis – left 77123177 Maximum $6,500.00
Ear prosthesis – right 77123189 Maximum $6,500.00
Elbow disarticulation – left – prosthesis 77123520 Maximum $3,860.00
Elbow disarticulation – right – prosthesis 77123521 Maximum $3,860.00
Hemipelvectomy – left – prosthesis 77123522 Maximum $4,950.00
Hemipelvectomy – right – prosthesis 77123523 Maximum $4,950.00
Hip disarticulation – left – prosthesis 77123440 Maximum $4,820.00
Hip disarticulation – right – prosthesis 77123438 Maximum $4,820.00
Knee disarticulation – left – prosthesis 77123487 Maximum $4,565.00
Knee disarticulation – right – prosthesis 77123475 Maximum $4,565.00
Nose prosthesis 77123501 Maximum $6,500.00
Ocular prosthesis – left 77123153 $3,000; or $3,100 (extra fitting required)
Ocular prosthesis – right 77123141 $3,000; or $3,100 (extra fitting required)
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 By approval
Prosthetic supplies – use only if NO pre-approval is required 77123232 Maximum $399.99
Prosthetic supplies – use if pre‑approval is required 77123530 By approval
Proximal femoral focal deficiency – left – prosthesis 77123524 Maximum $4,635.00
Proximal femoral focal deficiency – right – prosthesis 77123525 Maximum $4,635.00
Rotationplasty – left – prosthesis 77123526 Maximum $3,530.00
Rotationplasty – right – prosthesis 77123527 Maximum $3,530.00
Shoulder disarticulation – left – prosthesis 77123463 Maximum $3,940.00
Shoulder disarticulation – right – prosthesis 77123451 Maximum $3,940.00
Symes prosthesis – left – prosthesis 77123384 Maximum $3,365.00
Symes prosthesis – right – prosthesis 77123372 Maximum $3,365.00
Transfemoral (above knee) – left – prosthesis 77123359 Maximum $4,300.00
Transfemoral (above knee) – right – prosthesis 77123335 Maximum $4,300.00
Transfemoral (above knee) osseointegration – left – prosthesis 77123546 By approval
Transfemoral (above knee) osseointegration – right – prosthesis 77123547 By approval
Transhumeral (above elbow) – left – prosthesis 77123270 Maximum $3,090.00
Transhumeral (above elbow) – right – prosthesis 77123256 Maximum $3,090.00
Transmetatarsal – left – prosthesis 77123207 By approval
Transmetatarsal – right – prosthesis 77123190 By approval
Transradial (below elbow) – left – prosthesis 77123281 Maximum $2,650.00
Transradial (below elbow) – right – prosthesis 77123268 Maximum $2,650.00
Transtibial (below knee) – left – prosthesis 77123360 Maximum $3,420.00
Transtibial (below knee) – right – prosthesis 77123347 Maximum $3,420.00
Transtibial (below knee) osseointegration – left – prosthesis 77123559 By approval
Transtibial (below knee) osseointegration – right – prosthesis 77123558 By approval
Transtarsal – left – prosthesis 77123402 Maximum $2,760.00
Transtarsal – right – prosthesis 77123396 Maximum $2,760.00
Wrist disarticulation – left – prosthesis 77123518 Maximum $2,925.00
Wrist disarticulation – right – prosthesis 77123519 Maximum $2,925.00