Agencies
Services
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 |