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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

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DME-Equipment

Ambulatory Assistance Devices
Ankle-Foot/Knee-Ankle-Foot Orthosis
Back-Up Ventilators in the Home Setting
Home Ventilators
Canes & Crutches
Bathroom & Toilet Equipment & Supplies
Burn Garments
Cigna
Anthem
Cigna
Aetna
Aetna
Compression Garments for the Legs
Continuous Passive Motion (CPM) machines
Corset used as hernia support
Cranial Orthosis for Craniosynostosis and Plagiocephaly
Cryoanalgesia and Therapeutic Cold
Foot orthoses, foot care services
Gait trainers
Aetna
FlorideBlue
Aetna
Aetna
UHC
Humana
Cigna
Hand Orthotic
Heating pads and heat lamps
Hospital beds and Accessories
Knee Braces
Prefabricated and Prophylactic Knee Braces
Lymphedema and Venous Stasis Ulcer Treatments
Mechanical Stretching Devices for Contracture and Joint Stiffness
Cigna
Aetna
FlorideBlue
FlorideBlue
Anthem
Anthem
FlorideBlue
Aetna
UHC
Noninvasive Home Ventilator Therapy for Respiratory Failure
Orthopedic Footwear
Oxygen and Oxygen Equipment
Patient Lifts
Peak Flow Meters 
Pneumatic Compression Devices
Pressure Reducing Support Surfaces - Group 1
Anthem
Aetna
Humana
FlorideBlue
Cigna
Pressure Reducing Support Surfaces - Group 2
Pressure Reducing Support Surfaces - Group 3
Power Operated Vehicle (POV)
Refractive Lenses
Seat Lift Mechanisms
Scoliosis braces and casts
Seat Lift Mechanisms, Patient Lifts and Standing Devices
Anthem
Cigna
Spinal Orthoses: TLSO and LSO
Standing Frames
Therapeutic Chairs
Therapeutic Shoes for Persons with Diabetes
Vitrectomy Chair/Face-Down Positioning System
Walkers
Wheelchairs and Wheelchair Accessories
Medicare
Anthem
Anthem
Aetna
Anthem
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Indicates Non-covered Service

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Biomechanical Footwear Therapy
Continuous Passive Motion (CPM) machines
Home Traction Devices - Cervical & Lumbar
Home Video-Assisted Robotic Rehabilitation Systems
Pillows & Cushions
Anthem
Cigna
Cigna
Anthem
Aetna
Humana
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