Disposable Diapers and Liners for Incontinence

The November 2008 Medicaid Update informed providers and prescribers that longstanding coverage and payment rules for incontinence supplies would be enforced through additional claims processing editing.

Edit 00715, Procedure Conflicts with Previous Service, was activated in May 2009 for instances when the coverage and payment rules are not followed.

The following parameters provide further assistance to providers, prescribers and beneficiaries in understanding the coverage and payment rules:

• Disposable diapers and liners are covered for treatment of incontinence only when medical need is documented by the ordering practitioner and maintained in the beneficiary's clinical file.
• The quantity limits reflect amounts required to meet the medical need for beneficiaries' incontinence treatment plans.
• Up to 250 disposable diapers and/or liners are allowed per month, providing for up to 8 changes per day. Claims for any combination of diapers and/or liners over 250 per month will be denied.
• Over a six month period, up to 1750 disposable diapers and/or liners are allowed. This limit accounts for refills.
• Incontinence liners are not menstrual pads. Personal hygiene products such as menstrual pads are not covered.

For questions on billing, call Computer Sciences Corporation at (800) 343-9000.

For questions on policy and coding, call the Division of Provider Relations and Utilization Management at (800) 342-3005 option 1.