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See a sample rate comparisonHCPCS T4537 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.
Incontinence product, protective underpad, reusable, bed size, 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 T4537 |
National average reimbursement for HCPCS T4537 by major payers:
$18.33
$12.09
$1.45
$21.34
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HCPCS T4537
5 of 25 sample ratesHigher to lower in this preview
Lincare Inc.
$13.82Published rateUpstate Regional Medical Supply ,Inc.
Upstate Regional Medical Supply Inc
$13.43Published rateEverything Medical Equipment And Supplies Inc.
$13.43Published rateLewin Agency, Inc.
Lewin Agency Inc
$0.12Published rateSt. Peter'S Hospital Of The City Of Albany
St Peters Hospital
$0.12Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS T4537 vs. Other Incontinence Supplies Codes
The HCPCS T4537 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 T4537 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 |
|---|---|---|
| T4536-HCPCS | Low | Incontinence product, protective underwear/pull-on, reusable, any size, each |
| T4537-HCPCS | Low | Incontinence product, protective underpad, reusable, bed size, each |
| T4538-HCPCS | Low | Diaper service, reusable diaper, each diaper |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T4537. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T4537 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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