Benefit limitations for DME Incontinence Supplies

Date: August 14, 2026

Attention: Durable Medical Equipment (DME) Providers

Texas Children’s Health Plan (TCHP) provides access to medically necessary Durable Medical Equipment (DME) as supplies in accordance with covered member benefit plans. 

Incontinence supplies are subject to a benefit limitation of a combined total of 240 units per month within 4 weeks/one month period of time equivalent to 28 days. The limitation applies to covered incontinence products billed under applicable HCPCS codes below.

TCHP will temporarily allow services billed for T4521 – T4535, T4543, or T4544 using the monthly frequency of 27 days for dates of service August 1, 2026 – October 31, 2026 to be reimbursed. 

Effective November 1, 2026, the above exception will be removed as TCHP policy will continue to align with the Texas Medicaid Provider Procedures Manual (TMPPM) DME billing frequency of 28 days.

Next Steps

We encourage providers to review current billing practices and make any necessary adjustments to ensure alignment with these requirements prior to November 1, 2026. Reach out to your assigned Account Lead or Provider Relations Liaison (PRL) for questions or guidance. If you’re not sure who your PRL is, visit www.texaschildrenshealthplan.org/for-providers/meet-our-team.

Resources

Texas Medicaid Provider Procedures Manual (TMPPM), DME and Supplies

If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.

For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.