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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 : Incontinence Procedure Codes with Limitations
Any service or combination of services, except diaper wipes, requires prior authorization if the maximum limitation is exceeded. Requests for prior authorization of diaper wipes that exceed more than two boxes per month will not be considered through Home Health Services.
Refer to:
Subsection, “Diapers, Briefs, Pull-ons, and Liners” in this handbook for an explanation of the item limitations identified with an asterisk (*).
The following procedure codes always require prior authorization even if the maximum benefit limitation allowed has not been exceeded:

Texas Medicaid & Healthcare Partnership
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