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ACG
​
h.o.l.M.E.S.

Automated Clinical Guidelines

DME-Equipment

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

Indicates Non-covered Service

Home Traction Devices - Cervical & Lumbar
Cigna
Burn Garments
Aetna
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