HCPCS Code T4535: Disposable incontinence liner/pad/undergarment, each

Medicare Part B generally does not cover T4535; coverage status varies and is payer-specific. Coverage code M indicates “Non-covered by Medicare.” Private payers and Medicaid programs may offer coverage under defined conditions.

In West Virginia, coverage is available for patients aged 3 years or older, with a monthly limit of 180 units. Combined with A4520 (diapers) and A4554 (underpads), the maximum allowed is 250 total units/month. Exceeding these limits typically requires additional justification or may be denied.

Requirements often include a prescription or LMN, clinical justification of incontinence severity, age verification, and adherence to quantity limits. For example, MassHealth mandates clinical documentation and prior authorization forms to support absorbent products.