Incontinence Medical Supply Billing Requirements
| Date: | June 05, 2024 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Durable Medical Equipment (DME) and Medical Supply Providers |
| Type: | Regulatory |
| Subject: | Incontinence Medical Supply Billing Requirements |
| Business: | Medi-Cal Managed Care |
Through the new Claims Editing System (CES), Health Plan has identified when billing Incontinence Medical Supplies the secondary diagnosis is missing, invalid, or out of sequence.
Incontinence supplies are reimbursable only for use in chronic pathologic conditions causing the recipient’s incontinence. The primary ICD-10-CM and the secondary ICD-10-CM diagnosis codes must be entered on claims to reflect the condition causing the incontinence and the type of incontinence.
Only the following ICD-10-CM diagnosis codes are acceptable as a secondary diagnosis:
| F98.0, F98.1, N39.3, N39.41 thru N39.46, N39.490 thru N39.492, N39.498, R15.2, R15.9, R30.1, R32, R39.2, R39.81 thru R39.84, R39.89, R39.9 |
Claims received with a missing, invalid, or out of sequence diagnosis coded will be denied and a corrected claim submission will be required.
Other Need to Know Billing Requirements
Billing Codes
Please reference the List of Incontinence Absorbent Products for a list of covered products with corresponding HCPCS Code, UPN Qualifier, and UPN: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fmcweb.apps.prd.cammis.medi-cal.ca.gov%2Fassets%2F3FE1AF5B-DD98-4480-9825-09664AE7FA47%2Fincontlist.xlsx%3Faccess_token%3D6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO&wdOrigin=BROWSELINK
Quantity Limits
Please reference the List of Incontinence Medical Supply Billing Codes for a list of covered products with the corresponding HCPCS and Quantity Limits without authorizations: https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fmcweb.apps.prd.cammis.medi-cal.ca.gov%2Fassets%2F0CA735BE-75EE-419C-83D3-4BC6330381E8%2Fincontbilling.xlsx%3Faccess_token%3D6UyVkRRfByXTZEWIh8j8QaYylPyP5ULO&wdOrigin=BROWSELINK
Universal Product Number
Claims must also include Universal Product number (UPN) for the products dispensed as published in the referenced spreadsheets. The UPN on the claim must be the exact UPN for the product dispensed.
UPN Qualifier
The UPN qualifier is a two-character code that distinguishes the type of UPN. This code is required on every claim line that contains a UPN. Claims for incontinence supplies require the UPN qualifiers as published in the spreadsheets.
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website WWW.HPSJ-MVHP.ORG
