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Physician Resources: Diaper Coverage Information

IN ORDER FOR MEDICAID TO APPROVE COVERAGE FOR DIAPERS OR UNDERPADS THE FOLLOWING MUST BE MET:

*** THE PERCRIPTION & PLAN OF SERVICE MUST INCLUDE THE PATIENT’S HEIGHT AND WEIGHT AS WELL AS THE DATE OF THE LAST VISIT WITH THE PROVIDER.

*** THE PATIENT MUST HAVE A DIAGNOSIS CODE OF INCONTINENCE USUALLY ALONG WITH A SECONDARY DIANOSIS THAT MEETS B, C, OR D OF THE FOLLOWING:

*** The beneficiary must meet at least two of the following:

A. Unable to control bowel or bladder functions.

B. Unable to utilize regular toilet facilities due to documented medical condition.

C. Unable to physically turn self or reposition self.

D. Unable to transfer self from bed to chair or wheelchair without assistance.

*** ICD-9 Codes that support medical necessity are but not limited to:

788.30 Unspecified urinary incontinence

787.60 Full incontinence of feces

788.31 Urge incontinence

788.32 Stress incontinence, male

788.33 Mixed incontinence urge and stress (male) (female)

788.34 Incontinence without sensory awareness

Some additional codes that may support medical necessity are:

788.20 Unspecified retention of urine 788.39 Other urinary incontinence

788.21 Incomplete bladder emptying 787.61 Incomplete defecation

788.35 Post-void dribbling 787.62 Fecal smearing

788.29 Other specified retention of urine 787.63 Fecal urgency

788.36 Nocturnal enuresis

788.37 Continuous leakage

788.38 Overflow incontinence

*** IF PATIENT REQUIRES MORE THAN 6 DIAPERS/UNDERPADS, PLEASE INCLUDE SUPPORTING DOCUMENTATION FOR THE EXCESS SUPPLIES

Wings™ Choice Plus Adult Briefs SIZE CHART

60032 Small (20″ to 31″WAIST) 60035 X-Large (59″ to 64″WAIST)

60033 Medium (32″ to 44″WAIST) 67093 XXL (65″ to 69″WAIST)

60034 Large (45″ to 58″WAIST)

*** Some types of Medicaid plans do not cover incontinence supplies. Most plans have limits on the amounts of supplies that a patient can have each month. We will verify coverage on all patients prior to shipping diapers or underpads.