Provider Notice issued 05/14/14

Incontinence Supplies Monthly Limitations

​To: ​Enrolled Durable Medical Equipment and Supplies (DME) Providers and Pharmacies
​Date: ​May 14, 2014
​Re: ​Incontinence Supplies Monthly Limitations

In the June 15, 2012 informational notice, Incontinence Supplies Changes, the department outlined new policy regarding quantity maximums for incontinence supplies. This notice further clarifies those limitations.

The attached tables identify, by HCPCS code, the current incontinence products covered by HFS and quantity limits. Combinations of the products in Table 1 have a cumulative quantity limit of 200 per 30-day period. The products in Table 2 may be dispensed in addition to the products listed in Table 1.

As is current policy, whether prior approval is required or not, the quantity of medical supplies will be limited to the amount indicated by the ordering practitioner or to a reasonable quantity for a month, whichever is less. Providers must contact the patient prior to dispensing each item to ensure that the patient continues to want the same provider to serve his or her medical supply needs, and that the patient continues to need the items. The patient's medical eligibility must also be verified prior to dispensing the item.

Any questions regarding this notice may be directed to a DME billing consultant in the Bureau of Provider and Ancillary Services at 1-877-782-5565, option 3, then option 2.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs

HFS Incontinence Products Covered as of May 1, 2014

A quantity limit of 200 per 30-day period includes the combination of the following incontinence supplies:

Code

Description

Age Limit

T4521

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

4-99 Years

T4522

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

4-99 Years

T4523

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

4-99 Years

T4524

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

4-99 Years

T4525

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

4-99 Years

T4526

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

4-99 Years

T4527

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

4-99 Years

T4528

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

4-99 Years

T4529

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

4-99 Years

T4530

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

4-99 Years

T4531

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

4-99 Years

T4532

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

4-99 Years

T4533

Youth sized disposable incontinence product, brief/diaper, each

4-99 Years

T4534

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

4-99 Years

T4543

Disposable incontinence product, brief/diaper, bariatric, each

12-99 Years

The following products may be dispensed in addition to the products listed in the above table:

HCPCS Code

Description

Maximum/30 Days

Age Limit

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

 

 

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