 Diabetic equipment and supplies including external insulin pumps, infusion devices, blood glucose monitors, continuous glucose monitors, lancets, and injection aids.  Enteral pumps and supplies.  Home ultraviolet light therapy equipment for treatment of certain skin conditions such as cutaneous lymphoma, eczema, psoriasis, and scleroderma.  Osteogenic bone stimulators.  Osteogenic spine stimulators.  Oxygen and oxygen supplies.  Peak flow meters.  Ventilators.  Wheelchairs. Outpatient Durable Medical Equipment (DME) Exclusions  Comfort, convenience, or luxury equipment or features.  Devices for testing blood or other body substances (except diabetes blood glucose monitors and their supplies) unless specifically listed as covered in this “Durable Medical Equipment (DME) and External Prosthetic Devices and Orthotic Devices” section.  Exercise or hygiene equipment.  Modifications to your home or car.  More than one corrective appliance or artificial aid or item of DME, serving the same function or the same part of the body, except for necessary repairs, adjustments and replacements as specified in this “Durable Medical Equipment (DME) and External Prosthetic Devices and Orthotic Devices” section.  Non-medical items, such as sauna baths or elevators.  Repair or replacement of DME items due to loss or misuse.  Spare or duplicate use DME. External Prosthetic Devices and Orthotic Devices We cover External Prosthetic Devices and Orthotic Devices, subject to Utilization Review by Kaiser using criteria developed by Medical Group and approved by Kaiser, when the following are true:  The device is Medically Necessary to restore or maintain the ability to complete activities of daily living or essential job-related activities and that are not solely for comfort or convenience.  The device is required to replace all or part of an organ or extremity designated by CMS in the “L codes” of the Healthcare Common Procedure Coding System. This coverage includes all Services and supplies that are Medically Necessary for the effective use of an External Prosthetic Device or Orthotic Device, including formulating its design, fabrication, material and component selection, measurements, fittings, static and dynamic alignments, and instructing the patient in the use of the device. Internally implanted prosthetic and Orthotic Devices, such as pacemakers, intraocular lenses, cochlear implants, osseointegrated hearing devices, artificial hearts, artificial larynx, and hip joints, are not covered under this “External Prosthetic Devices and Orthotic Devices” benefit, but may be covered if they are implanted during a surgery that we are covering under another section of this “Benefit Details” section. Covered External Prosthetic Devices and Orthotic Devices include but are not limited to: EWCLGHDHP1983ACT0124 44 WAPEBB-CD-ACT