SCAN Health Plan : LCD DME

ID	Title	Effective Date	Revision Effective Date	End Date	Last Approval / Revision Date
L142	Ankle-Foot/Knee-Ankle-Foot Orthosis	10/1/1993	7/1/2007	N/A	7/12/2007
L13577	Automatic External Defibrillators	1/1/2004	7/1/2007	N/A	2/19/2008
L11485	Canes and Crutches	10/1/1993	7/1/2007	N/A	2/19/2008
L15300	Cervical Traction Devices	7/1/2004	1/1/2007	N/A	2/22/2007
L11567	Cold Therapy	4/1/1997	7/1/2007	N/A	2/19/2008
L11486	Commodes	10/1/1993	1/1/2007	N/A	2/19/2008
L171	Continuous Positive Airway Pressure System (CPAP)	10/1/1993	7/1/2007	N/A	7/12/2007
L11568	Enteral Nutrition	10/1/1993	1/1/2007	N/A	3/9/2007
L11452	Epoetin	10/1/1993	7/1/2007	N/A	2/19/2008
L11569	External Breast Prostheses	10/1/1993	7/1/2007	N/A	2/19/2008
L11570	External Infusion Pumps	10/1/1993	1/1/2007	N/A	11/10/2007
L194	Eye Prostheses	10/1/1993	7/1/2007	N/A	2/19/2008
L11571	Facial Prostheses	11/1/1996	7/1/2007	N/A	2/19/2008
L196	Glucose Monitors	10/1/1993	1/1/2007	N/A	2/19/2008
L12739	High Frequency Chest Wall Oscillation Devices	10/1/2003	7/1/2007	N/A	2/19/2008
L11487	Home Dialysis Supplies and Equipment	10/1/1993	1/1/2007	N/A	2/19/2008
L11572	Hospital Beds And Accessories	10/1/1993	7/1/2007	N/A	2/19/2008
L68	Immunosuppressive Drugs	10/1/1993	1/1/2007	N/A	2/19/2008
L12743	Infrared Heating Pad Systems	10/1/2003	7/1/2007	N/A	2/19/2008
L11573	Intrapulmonary Percussive Ventilation System	7/1/2002	7/1/2007	N/A	2/19/2008
L11453	Lower Limb Prostheses	3/1/1995	1/1/2007	N/A	2/19/2008
L11454	Manual Wheelchair Bases	10/1/1993	1/1/2007	N/A	2/19/2008
L12744	Mechanical In-exsufflation Devices	10/1/2003	7/1/2007	N/A	2/19/2008
L11488	Nebulizers	4/1/1997	7/1/2007	N/A	6/14/2007
L11489	Negative Pressure Wound Therapy Pumps	10/1/2000	7/1/2007	N/A	2/19/2008
L11574	Oral Anticancer Drugs	1/1/1999	7/1/2007	N/A	2/19/2008
L11575	Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)	1/1/1999	1/1/2007	N/A	2/19/2008
L11456	Orthopedic Footwear	1/1/1995	7/1/2007	N/A	2/19/2008
L11490	Osteogenesis Stimulators	10/1/1993	1/1/2007	N/A	2/19/2008
L11491	Ostomy Supplies	10/1/1993	1/1/2007	N/A	2/19/2008
L11457	Oxygen and Oxygen Equipment	10/1/1993	1/1/2007	N/A	2/19/2008
L11576	Parenteral Nutrition	10/1/1993	1/1/2007	N/A	2/19/2008
L11577	Patient Lifts	10/1/1993	7/1/2007	N/A	2/19/2008
L11492	Pneumatic Compression Devices	10/1/1993	1/1/2007	N/A	2/19/2008
L23598	Power Mobility Devices	10/1/2006	7/1/2007	N/A	2/19/2008
L11578	Pressure Reducing Support Surfaces - Group 1	10/1/1993	1/1/2007	N/A	2/19/2008
L11579	Pressure Reducing Support Surfaces - Group 2	10/1/1993	7/1/2007	N/A	2/19/2008
L11580	Pressure Reducing Support Surfaces - Group 3	10/1/1993	1/1/2007	N/A	2/19/2008
L51	Refractive Lenses	10/1/1993	7/1/2007	N/A	2/19/2008
L11493	Respiratory Assist Devices	10/1/1999	7/1/2007	N/A	7/12/2007
L96	Seat Lift Mechanisms	10/1/1993	1/1/2007	N/A	2/19/2008
L108	Speech Generating Devices	7/1/2001	7/1/2007	N/A	2/19/2008
L11459	Spinal Orthoses: TLSO and LSO	10/1/1993	1/1/2007	N/A	2/19/2008
L11494	Suction Pumps	10/1/1993	1/1/2007	N/A	2/19/2008
L11460	Surgical Dressings	10/1/1993	1/1/2007	N/A	2/19/2008
L157	Therapeutic Shoes for Persons with Diabetes	5/1/1993	7/1/2007	N/A	2/19/2008
L166	Tracheostomy Care Supplies	10/1/1993	7/1/2007	N/A	2/19/2008
L11495	Transcutaneous Electrical Nerve Stimulators (TENS)	10/1/1993	1/1/2007	N/A	2/19/2008
L11581	Urological Supplies	10/1/1993	1/1/2007	N/A	2/19/2008
L11461	Walkers	10/1/1993	7/1/2007	N/A	2/19/2008
L11462	Wheelchair Options/Accessories	10/1/1993	1/1/2007	N/A	11/10/2007
L15670	Wheelchair Seating	7/1/2004	7/1/2007	N/A	5/24/2007

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