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The following information about medical supplies and equipment changed on the MHCP Provider website. It will be of interest to case managers and service providers.
Updates listed here were made to the MHCP Provider Manual - Equipment and Supplies - Incontinence Products page:
Covered services
Under Covered Services, we added the following:
- Youth and adult-sized disposable briefs, diapers, protective underwear or pull-ons, liners, shields, guards, pads, and underpads are covered if they are listed on the MHCP Incontinence Product List (PDF).
- Any pediatric-sized product may be covered.
- We updated the tables with product combinations and quantity limits. Product combinations more than one size apart are not permitted.
Noncovered services
Under Noncovered Services, the following products and services are now not covered:
- Resuable underpads
- Small or chair-sized disposable underpads
- Disposable protective underwear or pull-ons, and disposable liners, shields, guards, pads, or undergarments for children under age 4
- Disposable adult- or youth-sized briefs or diapers, protective underwear or pull-ons, liners, shields, guards, pads, or undergarments, or underpads that are not on the MHCP Incontinence Products List when authorization has not been obtained.
- Use of a diaper service for cloth diapers
Authorization
Under Authorization, the following changes have been made:
- Only disposable briefs and diapers for members under age 4 are now covered. The first 300 units per month are the patient's responsibility. MHCP will authorize only the quantity that exceeds 300 per month.
- If the member is using a combination of products, documentation must now show all quantities of all products required.
- Authorization is now required for incontinence products that are not on the MHCP Incontinence Products List.
Billing and documentation
Under Billing and Documentation, the following changes have been made:
- A new physician's order is now required annually for all incontinence products, regardless of age.
- For code T4535, U1 modifier for moderate products and U2 for heavy products must be used.
- Claim lines for pediatric-sized disposable brief or diaper (or any pediatric-sized disposable protective underwear or pull-on without a product code) will now be denied.
- Claim lines for adult- and youth-sized disposable briefs or diapers, disposable protective underwear or pull-ons, disposable liners, shields, guards, pads and undergarments, and disposable underpads must now have a product code that matches a product code from the MHCP Incontinence Products List. Claim lines without a product code that matches the MHCP Incontinence Products List will now be denied unless authorized.
- If authorization is required, the claim must match HCPCS code, modifiers and product code as noted on the authorization letter.
- Providers can now dispense no more than a one-month supply.
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