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Insurance Coverage

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In order to have incontinence supplies covered through an insurance plan, there has to be a medical necessity for the item being requested.  Diapers are treated in the same manner as prescription medication.  Something has to be causing the incontinence, and a physician must convey that information by means of prescription, authorization, letter of medical necessity, or referral.  If covered, these types of supplies are typically provided either by a DME company, or a pharmacy.
 
Medicare does not cover any incontinence supplies, nor does any other federally funded program.
 
Some private insurances do cover incontinence supplies. Call the number on the back of your card to find out if your plan covers the items. 
 
Most State Medicaid programs do cover incontinence supplies. Each State has their own rules and regulations reguarding coverage. If you are a Medicaid Recipient, we strongly urge you to contact your Medicaid Plan, your case worker, or even your physician to see if you qualify for coverage.  Click Here to find the link to your state's Medicaid Program.
 
 
CPT Codes for Incontinence Supplies
T4521 Small Adult Diapers/Briefs
T4522 Medium Adult Diapers/Briefs BRX0 - 28467 - 63012 - 66032 - 42390 - WS43390
T4523 Large Adult Diapers/Briefs BRX0 - 28469 - 63014 - 66034 - 42590 - WS43590
T4524 X-Large Adult Diapers/Briefs BRX0 - 28470 - 63015 - 66035 - 42690 - WS43690
T4543 Adult Bariatric Briefs 31000 - BREZ1090 - WS43790
T4525 Small Adult Pull-Ons/Protective Underwear None
T4526 Medium Adult Pull-Ons/Protective Underwear 1605 - AP0720 - APP0720
T4527 Large Adult Pull-Ons/Protective Underwear 1615 - AP0730 - APP0730
T4528 X/Large Adult Pull-Ons/Protective Underwear 1625 - AP0740 - APP0740
T4529 Small/Medium Baby Diapers 80018A - 80028A - 80038A
T4530 Large/XLarge Baby Diapers 80048A - 80058A
T4531 Small/Medium Baby Pullups 70063GA - 70063BA
T4532 Large/XLarge Baby Pullups 70064GA - 70064BA - 70065GA - 70065BA
T4533 Youth Biefs/Diapers 25017 - 60031DP
T4534 Youth Pullups 70073A - 70074A - 70075A
T4535 Liners, Guards, Insert Pads 23246 - MG0400 - LP0X00 - BST0192 - IP0400
T4537 Reusable Underpads 13436
T4541 Disposable Underpads 7176 - UFPP-360
T4542 Disposable Underpads, Chair Size none