[Provider] Incontinent Supply Formulary, Rates for August 1, 2009

[Provider Notification]

MaineCare's new two-year contract with Invacare for incontinent supplies
starts August 1, 2009.  Procedure codes and pricing are listed below.
The pricing will apply to any supplies provided to MaineCare members on
or after August 1.  The incontinent supply formulary
<http://www.maine.gov/dhhs/oms/pdfs_doc/news_can_use/incontinent_formula
ry_080109.xls>  and incontinent supply FAQs
<http://www.maine.gov/dhhs/oms/pdfs_doc/news_can_use/incontinent_supp_FA
Qs_080109.doc>  are available on MaineCare's website.  

 

If you have questions about Invacare services or products, feel free to
contact Peter Kaplan by e-mail at pkaplan at invacare.com or by phone at
508-634-5133.  If you have questions about the Invacare contract, please
contact Jennifer Cook at 287-2705 or Jennifer.Cook at maine.gov .  

 

Thank you for serving MaineCare members.  




 

Procedure Description

Code

Invacare Price

 AQC * 40% 

Unit of Measure 

Wipes

T4335

$1.69

$2.36 

Box of 50* 

Non-sterile gloves per 100

A4927

$3.57 

$5.00 

Per box of 100

Adult size brief/diaper sm

T4521

$0.26 

$0.36 

Per piece (unit)**

Adult size brief/diaper med

T4522

$0.30 

$0.42 

Per piece (unit)

Adult size brief/diaper lg

T4523

$0.39 

$0.55 

Per piece (unit)

Adult size brief/diaper xl

T4524

$0.47 

$0.66 

Per piece (unit)

Adult size pull-on sm

T4525

$0.45 

$0.63 

Per piece (unit)

Adult size pull-on med

T4526

$0.39 

$0.55 

Per piece (unit)

Adult size pull-on lg

T4527

$0.45 

$0.63 

Per piece (unit)

Adult size pull-on xl

T4528

$0.56 

$0.78 

Per piece (unit)

Ped size brief/diaper sm/med

T4529

$0.35 

$0.49 

Per piece (unit)

Ped size brief/diaper lg

T4530

$0.46 

$0.64 

Per piece (unit)

Ped size pull-on sm/med

T4531

$0.46 

$0.64 

Per piece (unit)

Ped size pull-on lg

T4532

$0.57 

$0.80 

Per piece (unit)

Youth Size Brief/Diaper

T4533

$0.28 

$0.39 

Per piece (unit)

Youth size pull-on

T4534

$0.606 

$0.85 

Per piece (unit)

Disposable liner/ shield/ guard/ pad/ 
undergarment for incontinence

T4535

$0.32 

$0.45 

Per piece (unit)

Large disposable underpad

T4541

$0.17 

$0.24 

Per piece (unit)

Small disposable under pad

T4542

$0.11 

$0.15 

Per piece (unit)

Protective Underwear Reusable

T4536

$7.05 

$9.87 

Per piece (unit)

Reusable Underpads

T4537

$5.25 

$7.35 

Per piece (unit)

$6.65 

$9.31 

Per piece (unit)

Bariatric brief/ diaper

 T4543

$0.63 

$0.88 

Per piece (unit)

 

 

* Limit 8 boxes per month.  ** Example: a box of 16 units would be
billed $0.36 X 16 = $5.76

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