For those children requiring durable medical equipment the C.C.S./C.S.H.N. Program will pre-authorize payment for the following equipment if prescribed by the prior authorized subspecialist and included in the child's plan of care:
braces, splints, wheelchairs and appropriate attachments, special walkers, crutches and artificial limbs in compliance with Medicaid guidelines as outlined in Chapter VI: Section I, I tem D 13; p. 26; first pair only of corrective orthopedic shoes following serial casting or surgical correction if prescribed by the pediatric orthopedist; prosthetic eyes and replacements as outlined in these rules, Chapter VI; Section I, I tem E, p. 26; and/or prosthetic amplification devices only when pre-authorized in conjunction with reconstructive surgery of the auditory canal and/or ossicular chain and included in the treating subspecialist plan of care.10-144 C.M.R. ch. 272, § VII-D