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Update to Maximum Limitations for Incontinence Procedure Codes A4396 and A4399

Last updated on 4/12/2019

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

Beginning May 1, 2019, TMHP will update the Texas Medicaid Provider Procedures Manual, Durable Medical Equipment, Medical Supplies, and Nutritional Products Handbook, Subsection 2.2.14.9, “Incontinence Procedure Codes with Limitations.” The first table in this subsection lists procedure codes A4396 and A4399 with an incorrect maximum limitation of 1 per month. For both codes, the corrected maximum limitation will be 1 per day.

For more information, call the TMHP Contact Center at 800-925-9126.