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 |
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| 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 |
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