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See a sample rate comparisonHCPCS T4543 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.
Adult sized disposable incontinence product, protective brief/diaper, above extra large, 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 T4543 |
National average reimbursement for HCPCS T4543 by major payers:
$1.78
$0.92
$0.56
$1.20
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HCPCS T4543
5 of 25 sample ratesHigher to lower in this preview
Everything Medical Equipment And Supplies Inc.
$1.75Published rateDme Consulting Agency LLC
$1.75Published rateLincare Inc.
$1.37Published rateConnect Medical Products LLC
$0.92Published rateEliezer Klein
$0.58Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS T4543 vs. Other Incontinence Supplies Codes
The HCPCS T4543 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 T4543 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 |
|---|---|---|
| T4542-HCPCS | Low | Incontinence product, disposable underpad, small size, each |
| T4543-HCPCS | Low | Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
| T4544-HCPCS | Low | Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS T4543. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the T4543 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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