Alberta Health
AADL Approved Product List Seating Benefits and Wheelchair Accessories
Pricing effective July 1, 2017
Table of Contents
Approved Manufacturers 2Wheelchair Cushions 3Wheelchair Backrests 7Head Supports 11Upper Extremity Supports 12Thoracic Supports 14Pelvic Supports 15Lower Extremity Supports 16Wheelchair Accessories 18Other Postural Support Devices 20Maintenance & Repairs 21
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-1
Approved Seating Manufacturers
5 Minds Mobility Bob Farley [email protected]
Blake Medical Mike Dangerfield [email protected]
Bodypoint Jonathan Alexander [email protected]
Daher Manufacturing Inc Durga Liske [email protected]
Essential Medical Products Bob Farley [email protected]
Future Mobility Healthcare Katelynn Van Engelen [email protected]
Innovators 1993 Gordon White [email protected]
Invacare Tom Corbett [email protected]
Maple Leaf Wheelchair Nils Findlay [email protected]
Nighthawk Manufacturing Jason Fakeley [email protected]
nxt Brandon Strap [email protected]
Ottobock Craig Royal [email protected]
Physipro Lori Mayson [email protected]
Power Plus Mobility Mike Dangerfield [email protected]
Pride Mobility Products Mike Nantais [email protected]
Ride Designs Shelly Myers [email protected]
ROHO Jonathan Alexander [email protected]
Stealth Mike Nantais [email protected]
Sunrise Medical Jessica Mueller [email protected]
Symmetric Designs Lori Mayson [email protected]
Therafin Bob Farley [email protected]
Varilite Lori Mayson [email protected]
Vicair Brandon Strap [email protected]
Western Home Medical Bob Farley [email protected]
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-2
Wheelchair Cushions
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Cushions
Part-time wheelchair users are only eligible for V985
Occasional wheelchair users are only eligible for V990 (No Seating Assessment required)
Cat. No. Max. PriceQty./Freq.Seating Level
Wheelchair Cushion for Occasional User
A V990Sizes up to 20" x 20" $110.00 Each1 Cushion Per 3 Years
No Seating Assessment required
Wheelchair Cushion for Level A Seating
Needs
A V985Part-Time User, Sizes up to 20" x 20" $350.00 Each1 Cushion Per 3 Years
A V980Full-Time User, Sizes up to 20" x 20" $589.00 Each1 Cushion Per 3 Years
For V980 - Clients must be offered a choice of cushions that includes foam cushions and air immmersion cushions, without an upgrade cost.
"Air immersion cushion" is defined as a cushion that has a support surface with segmented air cells which allows for immersion of the body in order to provide pressure redistribution.
Wheelchair Cushion for Level B Seating
Needs
B N570Adjustable Positioning, Sizes up to 20" x 20" $719.00 Each1 Cushion Per 3 Years
"Adjustable positioning" means that the shape of the cushion can easily be adjusted to meet the client's positioning needs.
For N570 - Clients must be offered a choice of cushions that includes foam cushions and air immmersion cushions, without an upgrade cost.
"Air immersion cushion" is defined as a cushion that has a support surface with segmented air cells which allows for immersion of the body in order to provide pressure redistribution.
Wheelchair Cushion for Level C Seating
Needs
C N820Complex Cushion, Sizes up to 20" x 20" $910.00 Each1 Complex Cushion Per 3 Years
"Complex" means that the cushion is designed with aggressive contours to address significant postural issues.Cushion may be pre-contoured or custom-configured (built to a custom shape and size).Cushion may be commerically manufactured or custom-made.Price includes all hardware.
C N830Custom-Configured for Growth, All Sizes $1376.00 Each1 Complex Cushion Per 3 Years
A custom built cushion, may be commercially manufacutred or custom-made. Build to a custom ordered size and shape with ability to accommodate growth.Price includes all hardware.
C N840Custom-Contoured Foam, All Sizes $2191.00 Each1 Complex Cushion Per 3 Years
A custom built cushion, may be commercially manufactured or custom-made. Shape is customized to the exact anatomic contours of a specific client (e.g., shape-captured, foam-in-place).Price includes all hardware.
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-3
Wheelchair Cushions
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Cushions
Part-time wheelchair users are only eligible for V985
Occasional wheelchair users are only eligible for V990 (No Seating Assessment required)
Cat. No. Max. PriceQty./Freq.Seating Level
Wheelchair Cushion for Level C Seating
Needs
C N850Custom-Contoured Polypropylene Composite (or equivalent)All Sizes
$2300.00 Each1 Complex Cushion Per 3 Years
Criteria: Client must be able to independently self-propel wheelchair for both indoors and community.
A custom built cushion, may be commercially manufactured or custom-made. Shape is customized to the exact anatomic contours of a specific client (e.g., shape-captured).Price includes all hardware.
Options for Wheelchair Cushions
Cat. No. Max. PriceQty./Freq.Seating Level
Oversized / Heavy Duty Option for
Wheelchair Cushions
A V529Size ≥ 20" or Weight Capacity ≥ 350lbs $190.00 Each1 Cushion Option Per Cushion
Combine this catalogue number with the appropriate cushion catalogue number. Price is a maximum, the vendor must bill retail price. This catalogue number cannot be used to reduce upgrade costs.
Incontinence Cover
A V006All Sizes $135.00 Each1 Cushion Cover Per 12 Months
For clients with unmanaged incontinence.
Occasional wheelchair users are NOT eligible.
Postural Support Accessories for Cushions
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Lateral Thigh Support
A V864Adductor Added to Cushion - All Sizes $17.50 Each3 Seating Accessories Per 3 Years
Obliquity Pad/Build-up/Fluid Supplement
A V860All Sizes $51.30 Each3 Seating Accessories Per 3 Years
Wedge
A V861Full Wedge $127.30 Each3 Seating Accessories Per 3 Years
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-4
Wheelchair Cushions
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Postural Support Accessories for Cushions
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Wedge
A V862Hemi Wedge $49.40 Each3 Seating Accessories Per 3 Years
Medial Thigh Support
A V863Abductor Added to Cushion - All Sizes $35.00 Each3 Seating Accessories Per 3 Years
Lateral Pelvic Support
A V865Hip Guide Added to Cushion - All Sizes $17.50 Each3 Seating Accessories Per 3 Years
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-5
Wheelchair Cushions
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Early Replacement Cushions
Early Replacement Cushion catalogue numbers may be used to provide a replacement cushion to a client who has experienced a significant change in clinical condition.
To confirm previous consumption of a Early Replacement Cushion on the IVR or E-Business use one of the catalogue numbers listed below. Early Replacement Cushion catalogue numbers do not compete with other cushion catalogue numbers.
Note: Occasional and Part-time wheelchair users are NOT eligible for early replacement cushions.
Eligible reasons for early replacement:
Due to Size ChangeClient must meet the following criteria:
• Must have had the current cushion for at least 1 year.• Must be a change of at least 2 inches in the client's anatomic measurements, or if client exceeds weight capacity of current cushion.
The authorizer MUST indicate the change in anatomic measurements or weight on the 1250/Authorization.
Due to Skin Integrity IssuesClient must meet the following criteria:
• Must have had pressure wound at least Stage II.• Must have had the current cushion for at least 1 year.
The authorizer MUST indicate the following on the 1250/Authorization:• Stage and location of wound(s).• Indicate other wound prevention strategies that have been implemented.
Due to Significant Change in Functional StatusClient must meet the following criteria:
• Must have had the current cushion for at least 6 months.• Must have progressed from occassional/part-time wheelchair user to full-time wheelchair user.
The authorizer MUST indicate the change of fucntional status the 1250/Authorization.
Cat. No. Max. PriceQty./Freq.Seating Level
Adult Early Replacement Cushion
A V551Wheelchair Cushion for Level A Seating Needs
$589.00 Each1 Early Replacement Cushion Per Lifetime
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
B N559Wheelchair Cushion for Level B Seating Needs
$719.00 Each1 Early Replacement Cushion Per Lifetime
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
C N857Wheelchair Cushion for Level C Seating Needs
$1376.00 Each1 Early Replacement Cushion Per Lifetime
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-6
Wheelchair Cushions
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Early Replacement Cushions
Early Replacement Cushion catalogue numbers may be used to provide a replacement cushion to a client who has experienced a significant change in clinical condition.
To confirm previous consumption of a Early Replacement Cushion on the IVR or E-Business use one of the catalogue numbers listed below. Early Replacement Cushion catalogue numbers do not compete with other cushion catalogue numbers.
Note: Occasional and Part-time wheelchair users are NOT eligible for early replacement cushions.
Eligible reasons for early replacement:
Due to Size ChangeClient must meet the following criteria:
• Must have had the current cushion for at least 1 year.• Must be a change of at least 2 inches in the client's anatomic measurements, or if client exceeds weight capacity of current cushion.
The authorizer MUST indicate the change in anatomic measurements or weight on the 1250/Authorization.
Due to Skin Integrity IssuesClient must meet the following criteria:
• Must have had pressure wound at least Stage II.• Must have had the current cushion for at least 1 year.
The authorizer MUST indicate the following on the 1250/Authorization:• Stage and location of wound(s).• Indicate other wound prevention strategies that have been implemented.
Due to Significant Change in Functional StatusClient must meet the following criteria:
• Must have had the current cushion for at least 6 months.• Must have progressed from occassional/part-time wheelchair user to full-time wheelchair user.
The authorizer MUST indicate the change of fucntional status the 1250/Authorization.
Cat. No. Max. PriceQty./Freq.Seating Level
Pediatric Early Replacement Cushion
A V550Wheelchair Cushion for Level A Seating Needs
$589.00 Each1 Early Replacement Cushion Per 3 Years
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
B N555Wheelchair Cushion for Level B Seating Needs
$719.00 Each1 Early Replacement Cushion Per 3 Years
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
C N852Wheelchair Cushion for Level C Seating Needs
$1401.00 Each1 Early Replacement Cushion Per 3 Years
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-7
Wheelchair Backrests
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Backrests
Part-time wheelchair users are only eligible for V495.
Occasional wheelchair users are NOT eligible.
Prices listed include hardware.
Cat. No. Max. PriceQty./Freq.Seating Level
Backrest for Level A Seating Needs
A V495General Use - All Sizes $350.00 Each1 Backrest Per 3 Years
Part-time or full-time wheelchair user.Adjustable tension or rigid backrest.
Backrest for Level B Seating Needs
B N590Pre-contoured,Sizes up to 20" Wide x 20" Tall,≤3 " Contour Depth
$690.00 Each1 Backrest Per 3 Years
B N593Pre-contoured,Sizes up to 20" Wide x 20" Tall,>3"- 6" Contour Depth
$790.00 Each1 Backrest Per 3 Years
Backrest for Level C Seating Needs
C N891Pre-contoured,Sizes up to 20" Wide x 20" Tall,≥ 6" Contour Depth
$903.00 Each1 Backrest Per 3 Years
C N892Pre-Contoured, With Specialized Positioning, Sizes up to 20" Wide
$995.00 Each1 Backrest Per 3 Years
Specialized features include bi/multi-angular, grid back, air immersion back.
C N894Custom-Configured, All Sizes $1000.00 Each1 Complex Backrest Per 3 Years
A custom built backrest, may be commercially manufactured or custom-made.Built to a custom ordered size and shape.
C N896Custom-Configured for Growth, All Sizes $1301.00 Each1 Complex Backrest Per 3 Years
A custom built backrest, may be commercially manufacutred or custom-made.Built to a custom ordered size and shape with the ability to accommodate growth.
C N898Custom-Contoured Foam, All Sizes $2191.00 Each1 Complex Backrest Per 3 Years
A custom built backrest, may be commercially manufactured or custom-made.Shape is customized to the exact anatomic contours of a specific client (e.g., shape-captured, foam-in-place).
C N899Custom-Contoured Polypropylene Composite (or equivalent)All Sizes
$2900.00 Each1 Complex Backrest Per 3 Years
Criteria: Client must be able to independently self-propel wheelchair for both indoors and community.
A custom built backrest, may be commercially manufactured or custom-made. Shape is customized to the exact anatomic contours of a specific client (e.g., shape-captured).
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-8
Wheelchair Backrests
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Options for Backrests
Cat. No. Max. PriceQty./Freq.Seating Level
Oversized / Heavy Duty Option for Backrests
B N500Size > 20" Wide or Weight Capacity > 300lbs
$300.00 Each1 Backrest Option Per Backrest
Combine this catalogue number with the appropriate backrest catalogue number. Price is a maximum, the vendor must bill retail price. This catalogue number cannot be used to reduce upgrade costs.
Postural Support Accessories for Backrests
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Spinal Alignment Accessories
A V853Large/Small Lumbar $48.45 Each3 Seating Accessories Per 3 Years
A V854Lateral Shim $48.45 Each3 Seating Accessories Per 3 Years
A V855Post/Lateral Pelvic $48.45 Each3 Seating Accessories Per 3 Years
A V856Wedge $48.45 Each3 Seating Accessories Per 3 Years
Gel Insert
A V901Thoracic Area $69.00 Each3 Seating Accessories Per 3 Years
A V902Full Spinal Area $103.50 Each3 Seating Accessories Per 3 Years
A V903Full Back $137.08 Each3 Seating Accessories Per 3 Years
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-9
Wheelchair Backrests
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Early Replacement Backrests
Early Replacement Backrest catalogue numbers may be used to provide a replacement brackrest to a client who has experienced a significant change in clinical condition.
To confirm previous consumption of a Early Replacement Backrest on the IVR or E-Business use one of the catalogue numbers listed below. Early Replacement Backrest catalogue numbers do not compete with other backrest catalogue numbers.
Note: Occasional and Part-time wheelchair users are NOT eligible for early replacement backrests.
Eligible reasons for early replacement:
Due to Size ChangeClient must meet the following criteria:
• Must have had the current backrest for at least 1 year.• Must be a change of at least 2 inches in the client's anatomic measurements, or if client exceeds weight capacity of current backrest.
The authorizer MUST indicate the change in anatomic measurements or weight on the 1250/Authorization.
Due to Skin Integrity IssuesClient must meet the following criteria:
• Must have had pressure wound at least Stage II.• Must have had the current backrest for at least 1 year.
Document the following on 1250 form:• Stage and location of wound(s).• Indicate other wound prevention strategies that have been implemented.
Cat. No. Max. PriceQty./Freq.Seating Level
Adult Early Replacement Backrest
A V870Backrest for Level A Seating Needs $350.00 Each1 Early Replacement Backrest Per Lifetime
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
B N572Backrest for Level B Seating Needs $790.00 Each1 Early Replacement Backrest Per Lifetime
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
C N874Backrest for Level C Seating Needs $1301.00 Each1 Early Replacement Backrest Per Lifetime
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
Pediatric Early Replacement Backrest
A V871Backrest for Level A Seating Needs $350.00 Each1 Early Replacement Backrest Per 3 Years
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
B N573Backrest for Level B Seating Needs $790.00 Each1 Early Replacement Backrest Per 3 Years
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-10
Wheelchair Backrests
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Early Replacement Backrests
Early Replacement Backrest catalogue numbers may be used to provide a replacement brackrest to a client who has experienced a significant change in clinical condition.
To confirm previous consumption of a Early Replacement Backrest on the IVR or E-Business use one of the catalogue numbers listed below. Early Replacement Backrest catalogue numbers do not compete with other backrest catalogue numbers.
Note: Occasional and Part-time wheelchair users are NOT eligible for early replacement backrests.
Eligible reasons for early replacement:
Due to Size ChangeClient must meet the following criteria:
• Must have had the current backrest for at least 1 year.• Must be a change of at least 2 inches in the client's anatomic measurements, or if client exceeds weight capacity of current backrest.
The authorizer MUST indicate the change in anatomic measurements or weight on the 1250/Authorization.
Due to Skin Integrity IssuesClient must meet the following criteria:
• Must have had pressure wound at least Stage II.• Must have had the current backrest for at least 1 year.
Document the following on 1250 form:• Stage and location of wound(s).• Indicate other wound prevention strategies that have been implemented.
Cat. No. Max. PriceQty./Freq.Seating Level
Pediatric Early Replacement Backrest
C N875Backrest for Level C Seating Needs $1301.00 Each1 Early Replacement Backrest Per 3 Years
MUST clearly document the eligibility reason on the 1250 or E-business benefit note. See above for details.
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-11
Head Supports
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Head Support Pads
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Headrest/Neckrest Pad
A V081Standard Pad $190.00 Each1 Headrest Pad Per 3 Years
B N582Headrest with Lateral Support $255.00 Each1 Headrest Pad Per 3 Years
C N883Headrest with Lateral Support and Movable Lateral Extension
$511.43 Each1 Headrest Pad Per 3 Years
C N885Custom-Contoured $428.78 Each1 Headrest Pad Per 3 Years
C N887Headrest with Anterior Trunk Support $540.00 Each1 Headrest Pad Per 3 Years
Head Support Hardware
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Hardware for Headrest/Neckrest
A V338Standard Straight $165.00 Each1 Headrest Hardware Per 3 Years
B N533Multi-Axis Hardware $200.00 Each1 Headrest Hardware Per 3 Years
B N535Link or Goose Neck Style Multi-Axis $280.00 Each1 Headrest Hardware Per 3 Years
C N832Multi-Axis Flip Back $380.00 Each1 Headrest Hardware Per 3 Years
Options for Head Supports
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Adaptor Kit or Mounting Plate
A V085All Types $189.70 Each1 Adaptor Kit or Mounting Plate Per 3 Years
Tone Deflector
C N865All Types $265.00 Each1 Tone Deflector Per 3 Years
Head Strap
C N873Halo Strap or Fitted Head Strap $120.72 Each1 Head Strap Per 12 Months
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-12
Upper Extremity Supports
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Inferior Arm Supports
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Arm Strap
C N819Single Strap $96.94 Each4 Upper Ext. Support Straps Per 12 Months
Arm Trough or Channel
A V572Hardware and Pad $182.00 Each1 Arm Support Per Side Per 3 Years
A V574With Swivel Elevating Unit for Arm Trough $432.00 Each1 Arm Support Per Side Per 3 Years
A V577Arm Trough Tray Assembly $432.00 Each1 Arm Trough Per Side Per 3 Years
Modified Armrest
C N866Hardwear and Pad $168.74 Each1 Arm Support Per Side Per 3 Years
Trays
Occasional wheelchair users are NOT eligible.
All prices include hardware and tray.
Cat. No. Max. PriceQty./Freq.Seating Level
Wheelchair Tray
A V476Standard or Padded, Full or Half, Up to 18" Wide
$257.60 Each1 Arm Support Per 3 Years
A V542Standard or Padded, > 18" Wide $310.20 Each1 Arm Support Per 3 Years
C N851Custom-Made, Padded $510.07 Each1 Arm Support Per 3 Years
C N856Custom-Made for Communication Device $534.79 Each1 Arm Support Per 3 Years
Eligible for a client with Level B seating needs if authorized for a power wheelchair by Level C team.
C N854Custom-Made, Lexan, Added Lip $687.41 Each1 Arm Support Per 3 Years
C N880Custom-Made, Heavy Duty, Lexan $705.11 Each1 Arm Support Per 3 Years
C N881Custom-Made, Heavy Duty Bayonet, Lexan, Added Lip
$862.70 Each1 Arm Support Per 3 Years
Eligible for a client with Level B seating needs if authorized for a power wheelchair by Level C team.
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-13
Upper Extremity Supports
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Options & Accessories for Trays
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Elbow Stops
A V762• Elbow Stop Straight• Elbow Stop Curved• Elbow Stop Curved Extended• Extended Padded Elbow Stops
$90.00 Each1 Posterior Arm Support Per Arm Per 3 Years
C N843Added to Custom-Built Tray $201.85 Each1 Posterior Arm Support Per Arm Per 3 Years
Lateral Support
A V766• Lateral support• Lateral support Extended
$90.00 Each1 Lateral Thoracic Support Per Side Per 3 Years
Hand Block
A V769 $90.00 Each3 Tray Accessories Per 3 Years
Tray Customization
A V710Up to 1 Hour Labour $66.50 Each1 Tray Customization Per 3 Years
Clear Overlay for Speech Board
A V768 $90.00 Each3 Tray Accessories Per 3 Years
Bayonet Mounting on Tray
C N863 $213.15 Each1 Mounting of Tray Per 2 Years
Communication Board Mount to Seating
System
C N860 $312.13 Each1 Mounting of Tray Per 2 Years
Posterior Arm Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Shoulder Protraction Wedges
C N841All Sizes $96.94 Each1 Posterior Arm Support Per Arm Per 3 Years
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-14
Thoracic Supports
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Lateral Thoracic Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Lateral Thoracic Support
B N514Fixed Hardware and Pad $235.00 Each1 Lateral Thoracic Support Per Side Per 3 Years
C N849Swing-Away Hardware and Pad $365.00 Each1 Lateral Thoracic Support Per Side Per 3 Years
C N818Integrated Lateral Support $305.00 Each1 Lateral Thoracic Support Per Side Per 3 Years
For Level C backrests with an intergrated lateral support of >6".
Anterior Thoracic Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Chest Strap
B N541Single Horizontal Strap $94.00 Each1 Thoracic Support Strap Per 12 Months
B N525Butterfly Strap $193.00 Each1 Thoracic Support Strap Per 12 Months
B N505Waistcoat Style $283.56 Each1 Thoracic Support Strap Per 12 Months
Axilla Strap
C N817Single Strap $96.94 Each1 Axilla Support Per Side Per 12 Months
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-15
Pelvic Supports
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Lateral Pelvic Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Lateral Pelvic Support/Hip Bolster
B N588Hardware and Pad $85.00 Each1 Lateral Pelvic Support Per Side Per 2 Years
C N831Hardware and Pad $210.47 Each1 Lateral Pelvic Support Per Side Per 2 Years
Superior Pelvic Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Pelvic Strap
B N5272 or 4 Point $165.00 Each1 Pelvic Support Belt Per 12 Months
Sub-ASIS Support
C N805Sub-ASIS Belt $232.00 Each1 Pelvic Support Belt Per 12 Months
C N800Sub-ASIS Bar $417.14 Each1 Pelvic Support Belt Per 12 Months
Inferior Pelvic Supports
Occasional wheelchair users are NOT eligible.
Cat. No. Max. PriceQty./Freq.Seating Level
Solid Seat Base
A V554Stardard, Up to 18"x18" $94.00 Each1 Base Per 3 Years
A V556Heavy Duty, >18"x18 $143.00 Each1 Base Per 3 Years
C N855Custom Contoured, All Sizes $549.54 Each1 Base Per 3 Years
Drop Base
A V565Stardard, Up to 18"x18" $247.00 Each1 Base Per 3 Years
A V567Heavy Duty, Over 18" Wide $327.75 Each1 Base Per 3 Years
B N564Adjustable, Up to 18" Wide $376.00 Each1 Base Per 3 Years
B N566Adjustable, 18" - 22" Wide $441.00 Each1 Base Per 3 Years
C N862Padded, All Sizes $455.92 Each1 Base Per 3 Years
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-16
Lower Extremity Supports
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Lateral Thigh/Knee Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Abduction Strap
C N868Single Strap $96.94 Each3 Lower Ext. Support Straps Per 12 Months
Lateral Thigh Support/Adductors
B N814Hardware and Pad $150.00 Each1 Lateral Thigh Support Per Leg Per 3 Years
Neoprene Padding of Front Rigging
C N846All Sizes $106.89 Each1 Lateral Thigh Support Per Leg Per 3 Years
Medial Knee Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Abductor/Pommel
B N532Non-Removable Hardware and Pad $227.69 Each1 Medial Thigh Support Per 3 Years
B N523Removable Hardware and Pad $410.00 Each1 Medial Thigh Support Per 3 Years
C N877Flip-Down Hardware and Pad $540.00 Each1 Medial Thigh Support Per 3 Years
C N835Custom-Built Flip-Down Hardware and Pad $675.71 Each1 Medial Thigh Support Per 3 Years
Anterior Lower Leg Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Knee Block
C N829Hardware and Pads $505.54 Each1 Anterior Knee Support Per 3 Years
Shin Strap
C N821Single Strap $92.63 Each1 Anterior Knee Support Per 3 Years
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-17
Lower Extremity Supports
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Posterior Lower Leg Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Calf Support
A V617Bilateral Calf Strap or H-Strap $80.00 Each3 Lower Ext. Support Straps Per 12 Months
C N861Rigid Support $234.94 Each3 Lower Ext. Support Straps Per 12 Months
Foot & Ankle Supports
Cat. No. Max. PriceQty./Freq.Seating Level
Footstrap/Toe Loop
B N554Single Strap $31.00 Each3 Lower Ext. Support Straps Per 12 Months
Heel Loop/Ankle Strap
B N507Single Strap $92.63 Each3 Lower Ext. Support Straps Per 12 Months
B N571Ankle Hugger Style $187.00 Pair3 Lower Ext. Support Straps Per 12 Months
Modified Foot Support
A V619• Footbox/Foot Pocket• Modified/Adapted Footplate• Shoe Holders• Padded Footrests or Footboards
$179.55 Each1 Foot Support Per Foot Per 2 Years
Price represents cost for one side/foot. 1 footboard = quantity of 2, or 1 shoe holder = quantity of 1
Amputation Boards & Pads
No Seating Assessment required
Cat. No. Max. PriceQty./Freq.Seating Level
Amputee Board
A V581Standard, Up to 20" Wide $350.00 Each1 Base Per 3 Years
A V583Heavy Duty or Angle Board, Up to 28" x 22" $412.50 Each1 Base Per 3 Years
For clients who require weight capacity >250lbs or with bilateral amputations.
A V585Drop Seat Style, Up tp 22" x 18" $440.88 Each1 Base Per 3 Years
Pad for Amputee Board
A V579All Sizes $62.50 Each1 Amp. Pad Per Limb Per 2 Years
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-18
Wheelchair Accessories
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Hardware
Cat. No. Max. PriceQty./Freq.Seating Level
Clips or Hooks
B N537Standard Hooks $14.90 Each8 Clips or Hooks Per 3 Years
B N534Drop Base Mount Clips $26.30 Each8 Clips or Hooks Per 3 Years
B N538Locking Suspension Hook $34.63 Each8 Clips or Hooks Per 3 Years
Seat-to-Back Bracket
B N502Sliding 90 Degree Bracket $46.07 Each1 Seat-to-Back Bracket Per 3 Years
B N508Growth Bracket/Hardware $60.08 Each1 Seat-to-Back Bracket Per 3 Years
Clamp
B N531All Sizes $46.46 Each2 Clamps Per 3 Years
Spacer Hardware
B N510All Sizes $215.65 Per Pair
1 Pair of Space Hardware Per 3 Years
2nd Set Backrest Hardware
B N551Standard $311.00 Per Pair
1 2nd Back Hardware Per 3 Years
To transfer to a second wheelchair.
B N552Heavy Duty $381.90 Per Pair
1 2nd Back Hardware Per 3 Years
To transfer to a second wheelchair.
Hardware Kit for Belt or Strap
B N504All Sizes $24.70 Each1 Strap Hardware Kit Per 12 Months
Safety Strap
C N844Single Strap $103.00 Each1 Safety Strap Per 2 Years
To secrure insert to mobility base
Postural Support Hardware Not-Listed
C N836All Sizes $150.00 Each1 Misc. Hardware Per Side Per 3 Years
To be used in cases where there is a clinically assessed need for specific hardware that is not otherwise listed in the approved product list. This catalogue cannot be used to reduce upgrade costs or provide duplicate benefits. Utilization of this catalogue number will be closely monitored by AADL.
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-19
Wheelchair Accessories
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Options for Belts or Straps
Cat. No. Max. PriceQty./Freq.Seating Level
Padded Option for Strap
C N879Padding for single strap $120.69 Each4 Padded Options Per 12 Months
For custom-made straps only. Not eligible for commercially available straps.
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-20
Other Postural Support Devices
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Custom Inserts
Cat. No. Max. PriceQty./Freq.Seating Level
Custom-Made Commode Insert
C X047Includes: Back, Laterals, Footstraps, Chest Straps
Prior Approval1 Commode Insert Per 4 Years
Must be custom-made components only. Not eligible if off-the-shelf components can provide appropriate postural support. AADL does not fund pelvic straps to commodes.
Custom-Made Stroller Insert
B X636Includes: Head Support, Foam, Covering and Pelvic Strap
$1102.20 Each1 Stroller Insert Per 2 Years
Must be custom-made components only. Not eligible if off-the-shelf components can provide appropriate postural support.
Floor Sitter
Cat. No. Max. PriceQty./Freq.Seating Level
GRIP Seat
B X474 $172.00 Each1 Floor Sitter Per 2 Years
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-21
Maintenance & Repairs
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Replacement Components
Occasional wheelchair users are NOT eligible.
No Seating Assessment required. Clinical justification and explanation must be clearly indicated on the 1250 or E-business benefit note.
Cat. No. Max. PriceQty./Freq.Seating Level
Replacement Cover for Wheelchair Cushion
A V101Level A or B Cushion Cover - All Sizes $165.00 Each1 Cushion Cover Per 12 Months
C N801Level C Pre-Contoured Cushion Cover - All Sizes
$190.00 Each1 Cushion Cover Per 12 Months
C N806Level C Custom-Contoured Cushion Cover - All Sizes
$300.00 Each1 Cushion Cover Per 12 Months
Replacement Cover for Backrest
A V571Level A or B Backrest Cover - All Sizes $183.00 Each1 Backrest Cover Per 12 Months
C N869Level C Backrest Cover - All Sizes $333.45 Each1 Backrest Cover Per 12 Months
Replacement Foam for Backrest
B N513All Sizes $130.00 Each1 Replacement Backrest Foam Per 3 Years
Current foam must be outside of warranty (minimum 6 months).Ensure the current backrest will continue to meet the client's long term needs. The client is not eligible for a replacement backrest for 2 years after the replacement foam is provided.
Replacement Hardware for Backrest
B N567Standard $311.00 Per Pair
1 Replacement Backrest Hardware Per 3 Years
Current hardware must be outside of warranty (minimum 2 years).Ensure the current backrest will continue to meet the client's long term needs. The client will not be elibigle for a new backrest for 2 years after the replacement hardware is provided.
B N569Heavy Duty $381.90 Per Pair
1 Replacement Backrest Hardware Per 3 Years
Current hardware must be outside of warranty (minimum 2 years).Ensure the current backrest will continue to meet the client's long term needs. The client will not be elibigle for a new backrest for 2 years after the replacement hardware is provided.
Replacement Cover for Head Support
A V570All Sizes $120.00 Each1 Headrest Cover Per 12 Months
Replacement Cover for Lateral Thoracic
Support
B N549All Sizes $50.00 Each1 Lateral Cover Per Side Per 12 Months
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-22
Maintenance & Repairs
All benefits provided must meet the generic description.Level B or Level C benefits may be commercially available or custom-made by an Adaptive Seating Techician.
Replacement Components
Occasional wheelchair users are NOT eligible.
No Seating Assessment required. Clinical justification and explanation must be clearly indicated on the 1250 or E-business benefit note.
Cat. No. Max. PriceQty./Freq.Seating Level
Replacement Pad for Pediatric Lateral
Thoracic Support
C N847All Sizes $50.00 Each1 Replacement Pad Per 3 Years
May only be authorized due to growth or change in posture for a pediatric client
Modifications
Modification can only be authorized for existing systems, at least 6 months after the service date. Cannot be authorized for newly provided equipment.
Occasional wheelchair users are NOT eligible.
No Seating Assessment required. Clinical justification and explanation must be clearly indicated on the 1250 or E-business benefit note.
Cat. No. Max. PriceQty./Freq.Seating Level
Adjustments
A V596Growth of Seating System $67.00 Each3 Modifications Per 12 Months
A V599Adjustment of Postural Supports $35.00 Each3 Modifications Per 12 Months
Transfer System to New Wheelchair
A V594 $67.00 Each3 Modifications Per 12 Months
Eligible when client is provided a new wheelchair and fixed hardware must be transferred. Cannot be used to transfer a cushion only.
Repairs
For Level C seating components only.
Repairs can only be authorized for existing systems, at least 1 year after the service date. Cannot be authorized for newly provided equipment.
No Seating Assessment required. Must provide clinical justification in E-business notes.
Cat. No. Max. PriceQty./Freq.Seating Level
Repair to Custom-Made Device
C N842Labour Costs $17.00 Per 15 Min. Interval
8 Labour Units Per 12 Months
C N845Material Costs $20.00 Each8 Material Units Per 12 Months
Alberta Health - Pharmaceutical and Health BenefitsAlberta Aids to Daily Living Manual X- Seating and Wheelchair Accessories Approved Product List July 2017
©2017 Government of Alberta APL X-23