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See a sample rate comparisonHCPCS T4535 Fee Schedule
Last Verified: September 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Disposable liner/shield/guard/pad/undergarment, for incontinence, each
| Key Fact | Detail |
|---|---|
| Service Type | National Codes Established for State Medicaid Agencies Incontinence Supplies |
| Common Place of Service | None 99 - Other POS |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for T4535 |
National average reimbursement for HCPCS T4535 by major payers:
$0.62
$0.43
$1.37
$0.93
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HCPCS T4535
5 of 25 sample ratesHigher to lower in this preview
Lincare Inc.
$0.40Published rateSusan Scheftics Mastectomy Boutique
$0.20Published rateHealth System Services, Ltd.
$0.20Published rateDownstate Surgical & Medical Supply Inc
Downstate Surgical Medical Supply Inc
$0.18Published rateLiberty Respiratory Care Inc.
Liberty Respiratory Care Inc
$0.10Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS 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.
| Code | Complexity | Description |
|---|---|---|
| T4534-HCPCS | Low | Youth sized disposable incontinence product, protective underwear/pull-on, each |
| T4535-HCPCS | Low | Disposable liner/shield/guard/pad/undergarment, for incontinence, each |
| T4536-HCPCS | Low | Incontinence product, protective underwear/pull-on, reusable, any size, each |
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.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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