Update to Fee Schedule for Certain Incontinence Supplies

UPDATED 3/15 – New York State has delayed new Medicaid pricing until March 15, 2017. See the State’s notice regarding incontinence supply pricing here: https://www.emedny.org/

MetroPlus is in process of amending our DME/O&P contracts to adjust reimbursement for certain incontinence supplies, in light of recent New York State Medicaid Fee Schedule updates. Your contracted reimbursement shall remain the same, with the following exception:


For the codes listed below, MetroPlus shall reimburse provider at a fee equivalent to 100% of the updated New York State Medicaid fee schedule. All other rates shall remain the same. You will be receiving a formal amendment shortly. The effective date of this pricing change will be March 15, 2017, provided the State does not further delay the incontinence pricing change implementation.


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Code Description
A4554 Disposable Underpads
T4521 Disposable Adult Small Diaper
T4522 Disposable Adult Medium Diaper
T4523 Disposable Adult Large Diaper
T4524 Disposable Adult Extra Large Diaper
T4529 Disposable Pediatric Small/Medium Diaper
T4535 Disposable Liners/Pads
T4537 Reusable Underpad, Bed Size
T4540 Reusable Underpad, Chair Size
T4543 Disposable Bariatric Diaper
Regarding Update to MetroPlus Fee Schedule for Certain Incontinence Supplies (PDF)