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    v1.0.28
    OpenPayerBilling CodesNational Codes Established for State Medicaid AgenciesHCPCS hcpcs-t4543-adult-disposable-protective-brief-above-xl
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    HCPCS Level II T4543: Adult Disposable Incontinence Protective Brief, Above XL

    HCPCS Level II code T4543 describes an adult-sized disposable incontinence protective brief/diaper sized above extra large, intended as a single-use absorbent garment for continence management; service type is supply of a protective brief/diaper and typical site of service is home care or long-term care settings where disposable incontinence products are used for patient continence management.

    For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Prior Authorization for Durable Medical Equipment (DME), Breast Pumps.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient scenario involves an adult patient with chronic urinary or fecal incontinence who requires disposable protective briefs sized above extra large for ambulatory or facility-based use. The product T4543 is supplied when a clinician, durable medical equipment (DME) supplier, nursing facility, or home health agency documents medical necessity for an adult-sized disposable incontinence brief (protective brief/diaper) that is larger than extra large.

    Clinical workflow: The treating clinician (primary care physician, geriatrician, wound care nurse, or home health clinician) documents the diagnosis and functional limitations that justify incontinent supplies. A plan of care or DME order specifies size, product type, quantity, and frequency. The DME supplier verifies coverage and beneficiary eligibility, collects the order and any required documentation (physician signature, frequency/quantity justification, and supporting notes such as mobility status or skin breakdown risk), dispenses T4543 to the patient or facility, and submits the claim with appropriate modifier(s) reflecting supplier status or circumstances of service. Typical sites of service include the patient’s home, skilled nursing facility, long-term acute care hospital, or outpatient clinic supporting transitional care.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99304Initial nursing facility care, per day, for the evaluation and management of a patientUsed when an initial facility evaluation documents need for incontinence supplies and establishes the plan of care.
    99307Subsequent nursing facility care, per day, for the evaluation and management of a patientUsed to document ongoing assessments and continued medical necessity for supplies during facility stay.
    99501Home visit for evaluation and management of a patient, low complexityUsed when home health clinicians or providers perform a visit that includes assessment and ordering of incontinence products.
    97597Debridement, open wound, selective debridement; first 20 sq cm or lessUsed when wound care requiring debridement is performed and incontinence management is part of skin protection strategy.
    99406Smoking and tobacco use cessation counseling visit, intermediateBehavioral or counseling codes occasionally appear in comprehensive care plans addressing contributing factors to incontinence when relevant.

    Related Modifiers

    5 rows

    Modifier
    [object Object]
    23
    95
    22
    2P

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    251S00000XCommunity/Behavioral Health AgencyA private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, intell…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    251B00000XCase Management AgencyAn organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access…
    156F00000XTechnician/TechnologistA broad category grouping different kinds of technologists and technicians. See individual definitions.
    2471C1106XCardiac-Interventional Technology Radiologic TechnologistA radiologic technologist who specializes in cardiac interventional and is appropriately educated and trained, consistent with nationally recognized s…
    261QR0400XRehabilitation Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    293D00000XPhysiological LaboratoryA laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans,…

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    E11.21Type 2 diabetes mellitus with diabetic nephropathy
    E86.0Dehydration
    F03.90Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
    G81.90Hemiplegia, unspecified affecting unspecified side
    G82.20Paraplegia, unspecified
    I69.391Dysphagia following cerebral infarction
    I69.398Other sequelae of cerebral infarction
    M62.81Muscle weakness (generalized)
    M62.82Rhabdomyolysis
    N13.8Other obstructive and reflux uropathy

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 2

    10 rows

    PolicyPayerEffective Date
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01
    Breast PumpsModa Health2026-09-01
    Personal Emergency Response SystemsCareSource Georgia2026-09-01
    Continuous Passive Motion (CPM) DevicesCigna2026-08-15
    Push-Rim Activated Power-Assist Device (E0986) — Manual Wheelchair Accessorymoda_health_plan_inc2026-08-13
    Beds and Mattresses (for Ohio Only)Colorado Rocky Mountain Health Plans2026-08-01
    Beds and Mattresses (for Kentucky Only)UnitedHealthcare2026-08-01
    Pneumatic Compression Devices (for Nebraska Only)UnitedHealthcare2026-08-01
    Indications for Coverage — Hospital beds, support surfaces, and safety enclosure beds (DME)Colorado Rocky Mountain Health Plans2026-08-01

    Related Codes

    HCPCS-LEVEL-II-T1030-NURSING-CARE-HOME-REGISTERED-NURSE-PER-DIEM

    HCPCS Level II T1030: Nursing Care in Home by Registered Nurse, Per Diem

    HCPCS-LEVEL-II-T2014-PREVOCATIONAL-HABILITATION-PER-DIEM

    HCPCS Level II T2014: Habilitation, Prevocational, Waiver; Per Diem

    HCPCS-LEVEL-II-T2020-DAY-HABILITATION-WAIVER-PER-DIEM

    HCPCS Level II T2020: Day Habilitation, Waiver; Per Diem

    HCPCS-LEVEL-II-T2047-HABILITATION-PREVOCATIONAL-WAIVER

    HCPCS Level II T2047: Habilitation Prevocational Waiver, per 15 minutes

    HCPCS-LEVEL-II-T4535-DISPOSABLE-INCONTINENCE-LINER-PAD

    HCPCS Level II T4535: Disposable Incontinence Liner/Pad

    HCPCS-LEVEL-II-T4538-REUSABLE-DIAPER-PER-DIAPER

    HCPCS Level II T4538: Reusable Diaper, Each

    HCPCS-T1000-PRIVATE-DUTY-LICENSED-NURSING-15-MIN

    HCPCS Level II T1000: Private Duty Licensed Nursing, up to 15 Minutes

    HCPCS-T1001-NURSING-ASSESSMENT-EVALUATION

    HCPCS Level II T1001: Nursing Assessment/Evaluation

    HCPCS-T1002-RN-SERVICES-15-MINUTES

    HCPCS T1002: RN Services, Up to 15 Minutes

    HCPCS-T1003-LPN-LVN-SERVICES-15-MINUTES

    HCPCS Level II T1003: LPN/LVN Services, Up to 15 Minutes

    Showing 1–10 of 113

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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