Common Services Under the Alliance Authorization ...

1 Common Services Under the Alliance Authorization Categories Durable Medical Equipment (DME) Inpatient Outpatient Pharmacy (Only to be used by pharmacies and PAD providers) Referrals Transportation Wheelchairs Apnea Monitor Beds/Lifts Blood Pressure Monitor Braces (Back, Knee) Cane Comp. Garments CPAP/ BiPAP Diabetic Inserts Diabetic Shoes Hearing Aids & Repairs Incontinence Products IV therapy supplies Lower ExtremityProsthesis Mastectomy Bra Mastectomy BreastProsthesis Medical Supplies Nebulizers/ Supplies Ocular prosthesis (eye) Prosthetics - Other Ostomy Supplies O2/Respiratory Supplies Pumps (breast, infusion,suction) TENS/Supplies Tracheotomy Supplies Wound Care Supplies Wound Vacs Other Long Term Care Post-Service InpatientServices Pre-Service InpatientServices Surgical/OtherProcedures Acupuncture Adult Day CareServices Apligraf Cataract RelatedServices Cystourethroscopy Dental Anesthesia Diabetic Counseling Heart Cath Hernia Repair Home Health Hospice Injections Laparoscopy MOHS Procedure/Surgery OccupationalTherapy Orchiopexy Pain Specialist Pilot Physical Therapy Radiology Sleep Testing Speech Therapy Surgery Other Urethrocystography Medication NutritionalSupplements PhysicianAdministered Drugs Specialty Referral to localspecialist Referral to localrehab therapist Referral to localfacility Referral to out ofarea specialist Referral to out ofarea facility Non-EmergentTransportation Anti-tippers Leg rests Manual Wheelchair Manual WheelchairAccessories Manual

2 WheelchairAccessories relatedto a repair Manual WheelchairRepairs Power wheelchair Power wheelchairaccessories Power wheelchairaccessories relatedto a repair Power wheelchairrepairs