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Product Name	Covered/ Denied	Explanation
ORTHOTIC BRACES	C	if medically necessary to restrict mobility to facilitate healing following an injury or surgical procedure.
OSTOMY EQUIPMENT AND SUPPLIES	C	if medically necessary for a patient whose ability to eliminate waste has been severely impaired. The patient's medical record must reflect the judgment of the attending physician that the impairment will be of a long and indefinite duration. Patients must be diagnosed with an ostomy (a surgically created opening (stoma) to divert urine, feces or ileal contents outside the body). If coverage is established, all related equipment and supplies are also covered, including colostomy and other ostomy bags, irrigation and flushing equipment, and other items directly related to ostomy care, whether or not the attachment of a bag is required. The quantity of ostomy supplies needed by a patient is determined by the type of ostomy, its location, its construction, and the condition of the skin surface surrounding the stoma. Utilization Limits for supplies 10 wafers per month 10 pouches per month
OVER BED TABLE	D	convenience item; not primarily medical in nature.
OXYGEN SYSTEM	C	Provided the following conditions are met: the attending physician has determined that the patient suffers from a severe lung disease or hypoxia-related symptoms that might be expected to improve with oxygen therapy, the patient's blood gas levels indicate the need for oxygen therapy, and alternative treatment measures have been tried or considered and have been deemed clinically ineffective. Covered Blood Gas Levels if the patient is diagnosed with significant hypoxemia evidenced by any of the following: if P02 < 55mm Hg; OR SaO2 < 88%, taken at rest, on room air; or during sleep and diagnosed with corpulmonale, "P" pulmonale on EKG, documented hypertension or erythrocytosis; or during exercise on room air and documented that the oxygen improves the hypoxemia. If P02 > 56mm Hg and < 59mm Hg; OR SaO2 = 89% and any of the following: dependent edema suggesting Congestive Heart Failure, pulmonary hypertension or corpulmonale; or erythrocythemia with a hematocrit > 56%. If oxygen therapy coverage is approved, the coverage applies regardless of delivery system chosen. PHILCARE does NOT provide Liquid Oxygen Systems. Please contact an alternate supplier. A physician's written prescription must include: diagnosis of the disease requiring oxygen therapy (see above) the oxygen flow rate (e.g., 2 liters per minute) the frequency and duration of oxygen use (e.g., 10 minutes hour, 12 hours per day) the duration of oxygen need (e.g., 4-12 months or lifetime). Supplies If coverage is approved, any equipment and supplies necessary to the patient's use of covered home oxygen therapy, like regulators (flow meters), humidifiers and face masks, are also covered.
OXYGEN SYSTEM (PORTABLE)	C	if the patient qualifies for reimbursement under the oxygen coverage guidelines noted above, and the patient is mobile within the home. NOT COVERED if primarily used for ambulating outside the home. Preset portable oxygen units (i.e., units in which the flow rate is not adjustable) are considered first aid or precautionary equipment; essentially not therapeutic in nature.

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