Table of Contents Previous Next

December 2016 Texas Medicaid Provider Procedures Manual

Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook : 2 Texas Medicaid (Title XIX) Home Health Services : 2.2 Services, Benefits, Limitations and Prior Authorization : 2.2.13 Incontinence Supplies : 2.2.13.4 Underpads

2.2.13.4
For clients who are 4 years of age and older and are receiving diapers/briefs/pull-ons/liners/urine collection devices/bowel management supplies, up to a maximum of 120 underpads per month may be considered without prior authorization. Quantities in excess of 120 per month may be considered with documentation of medical necessity and prior authorization.
Reusable underpads are not a benefit of Home Health Services.
Note:
The Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form for the supplies listed above must reflect no more than a one-month’s supply of the incontinence product. The Home Health Services (Title XIX) Durable Medical Equipment (DME)/Medical Supplies Physician Order Form must not reflect more than the maximum allowed quantity per month without requesting prior authorization.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.