CurrentAlaska MedicaidPolicy N/A

Medicaid coverage of disposable incontinence products (sizes and monthly quantities) for recipients aged three years and older

Defines Alaska Medicaid payment and quantity limits for disposable incontinence supplies (HCPCS T4521-T4535, T4543-T4544) for recipients aged three years and older, and explains authorization and appeals handling for quantities and mixed-size claims. Affects DME providers billing Alaska Medicaid.

Policy Summary

PayerAlaska Medicaid

PolicyDisposable incontinence products—sizes and monthly quantity clarification

Policy CodePolicy N/A

Change TypeClarification

Effective DateN/A

Next Review DateN/A

Key ActionObtain an approved Service Authorization when dispensing more than 180 units in a month (combined across listed HCPCS codes).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

180maximum allowed quantity per month without service authorization (all listed products combined)

T4521-T4535, T4543-T4544HCPCS codes covered by this clarification

3 yrsminimum recipient age eligible for payment

Coverage Criteria and Operational Rules

Coverage criteria and operational rules

Policy Summary

PayerAlaska Medicaid

PolicyDisposable incontinence products—sizes and monthly quantity clarification

Policy CodePolicy N/A

Change TypeClarification

Effective DateN/A

Next Review DateN/A

Key ActionObtain an approved Service Authorization when dispensing more than 180 units in a month (combined across listed HCPCS codes).

SourceLink

On This Page

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Coverage is limited to recipients aged three years or older.

Per state regulation 7 AAC 120.200(b).

Covered HCPCS codes: T4521-T4535 and T4543-T4544.

Monthly quantity limit without Service Authorization (SA): up to 180 units total per month combined across all listed HCPCS codes.

Each product has its own per-code allotment, but the combined total may not exceed 180 units/month without an approved SA.

ALL of the following

Any request for quantities greater than 180 units in a month for a single product or any combination of listed products requires an approved Service Authorization (SA).

ALL of the following

When multiple sizes or different HCPCS codes are dispensed in the same month, secondary claim lines for different size products may deny for NCCI/MUE and cannot be overridden at the claim level.
Providers must use the appeals process to request reimbursement for denied lines; timely appeals are required.
Providers have discretion to select appropriate sizes for individuals, but certain combinations are inappropriate to dispense together without an SA; first‑level appeals for such unsupported combinations will be denied.
Second‑level appeals for dispensing wider sizes must be supported with sufficient documentation demonstrating medical necessity for the larger size(s).

Covered HCPCS Codes and Quantity Limits

Covered HCPCS codesHCPCSCovered

T4521-T4535	Disposable incontinence products (various sizes/types)
T4543-T4544	Additional disposable incontinence products

Monthly quantity policy (no Service Authorization)mixed

180 units per month	Combined total across all listed HCPCS codes allowed without an approved Service Authorization (SA).
Service Authorization required	Quantities higher than 180 per month for any single product or any combination of listed products requires an approved SA.

Monthly quantity without service authorization — combined cap

Combined monthly cap without Service Authorization180 units per month total across all listed HCPCS codes (T4521-T4535, T4543-T4544)

Applies toAll disposable incontinence products identified by HCPCS T4521-T4535 and T4543-T4544

Per-product allotmentsEach product has its own monthly allotment on the fee schedule, but combined dispensing counts toward the 180-unit cap

Authorization, Appeals, and Billing Actions

Prior Authorization

Obtain Service Authorization for >180 units/month

Quantities higher than 180 units per month for any single listed product or for any combination of the listed HCPCS codes require an approved Service Authorization (SA). This 180-unit cap is the total combined monthly allowance across HCPCS T4521–T4535 and T4543–T4544 without an SA.

Applies to single products and any combination of the listed HCPCS codes in the same month.
Obtain an approved SA before dispensing or billing amounts that exceed 180 units in a calendar month.

Denial Risk

Appeal NCCI/MUE denials for mixed-size lines (no claim override)

Secondary claim lines for different-size listed products will deny for NCCI/MUE and these denials cannot be overridden at the claim level; providers must use the appeals process to request reimbursement for denied lines.

Do not attempt claim-level overrides for NCCI/MUE denials; file timely appeals instead.
First-level appeals for combinations not listed as appropriate without an SA will be denied; second-level appeals require sufficient documentation supporting the dispensing (e.g., justification for wider sizes).

Key Definitions

Definition: Disposable incontinence products

Included item typesDiapers, liners, underpads, reusable protective underpads, wipes, and washcloths

Eligible recipientsRecipients three years of age or older

AuthorityPayment allowed in accordance with 7 AAC 120.200(b)

Service Authorization note for quantities above cap

Service Authorization requirementAn approved Service Authorization (SA) is required when monthly quantities exceed 180 units combined across the listed HCPCS codes

ScopeRequirement applies to quantities above 180 for any single product or any combination of listed products

Reference ruleQuantities up to 180 per month allowed without SA per the Alaska Medicaid DMEPOS Interim Fee Schedule