Provider Notice issued 06/15/12

Incontinence Supplies Changes

To:​ Enrolled Durable Medical Equipment and Supplies (DME) Providers and Pharmacies ​
​Date: ​June 15, 2012
​Re: Incontinence Supplies Changes ​

HFS, as part of ongoing budget management, has reviewed its policy regarding incontinence supplies.

Currently, the department’s maximum for incontinence products is 300 items in a 30-day period, with no prior approval needed. Patients are also eligible to receive underpads at 300 in a 30-day period with no prior approval.

Effective with dates of service on and after July 1, 2012, HFS is implementing stricter control over these supplies. The department is revising the DME Fee Schedule to reflect changes to the maximums for incontinence supplies. Additionally, the minimum patient age limit is being raised on all codes. As has been policy, providers may submit an HFS 1409 (pdf) Prior Approval Request for a patient who has a documented medical need for an item beyond the parameters set by the department.   

HFS also reminds providers that substituting feminine hygiene products for liners or other true incontinence products is not permitted. Feminine hygiene products are not created to hold liquid content and protect the skin as incontinence products do. Failure to follow this policy may result in an audit finding and subsequent recoupment of payment or other administrative actions.

The supplies codes and their revisions are identified in the table with this notice. Any questions regarding this notice may be directed to a DME billing consultant in the Bureau of Comprehensive Health Services at 877-782-5565, Option 3, Option 2.

Theresa A. Eagleson, Administrator

Division of Medical Programs

 

Incontinence Products Changes
Effective with Dates of Service On and After July 1, 2012

 

Code

Description

Maximum/30 Days

Age Limit

T4521

Adult sized disposable incontinence product, brief/diaper, small, each

200/30 Days

4-99 Years

T4522

Adult sized disposable incontinence product, brief/diaper, medium, each

200/30 Days

4-99 Years

T4523

Adult sized disposable incontinence product, brief/diaper, large, each

200/30 Days

4-99 Years

T4524

Adult sized disposable incontinence product, brief/diaper, extra large, each

200/30 Days

4-99 Years

T4525

Adult sized disposable incontinence product, protective underwear/pull-on, small size, each

200/30 Days

4-99 Years

T4526

Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each

200/30 Days

4-99 Years

T4527

Adult sized disposable incontinence product, protective underwear/pull-on, large size, each

200/30 Days

4-99 Years

T4528

Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each

200/30 Days

4-99 Years

T4529

Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each

200/30 Days

4-99 Years

T4530

Pediatric sized disposable incontinence product, brief/diaper, large size, each

200/30 Days

4-99 Years

T4531

Pediatric sized disposable incontinence product, protective underwear/pull-on, small-medium  size, each

200/30 Days

4-99 Years

T4532

Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each

200/30 Days

4-99 Years

T4533

Youth sized disposable incontinence product, brief/diaper, each

200/30 Days

4-99 Years

T4534

Youth sized disposable incontinence product, protective underwear/pull-on, each

200/30 Days

4-99 Years

T4535

Disposable liner/shield/guard/pad/undergarment, for incontinence, each

120/30 Days

4-99 Years

T4541

Incontinence product, disposable underpad, large, each

150/30 Days

4-99 Years

T4542

Incontinence product, disposable underpad, small size, each

Eliminated

Eliminated

T4543

Disposable incontinence product, brief/diaper, bariatric, each

200/30 Days

12-99 Years