HCPCS T4535 Fee Schedule

HCPCS T4535 vs. Other Incontinence Supplies Codes

The HCPCS T4535 code is part of the National Codes Established for State Medicaid Agencies services used for Incontinence Supplies. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The HCPCS T4535 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T4535. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the T4535 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.