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Incontinence

Provider Type

  • Physicians (does not apply to Cal MediConnect)
  • Participating Physician Groups (PPG)
  • Hospitals
  • Ancillary

Incontinence medical supplies are covered when prescribed by licensed, in-network providers within their scope of practice for the treatment of members who are incontinent. Health Net contracts with J&B Medical Supply Company, Inc, Shield California Healthcare and Byram to provide these supplies. Incontinence medical supplies include disposable diapers, protective underwear (pull-on products), underpads, belted undergarments, shields, liners, pants and pad systems, pads, and reusable underwear.

Incontinence medical supplies are covered for use only when the member's incontinence is caused by chronic pathologic conditions. When incontinence is a short-term problem or when there is no underlying pathologic condition causing it, incontinence supplies are not covered.

Providers must document the following in the member's medical record to support the need for prescribed incontinence medical supplies:

  • Diagnosis for the medical condition and diagnosis causing incontinence.
  • Diagnosis for the type of incontinence for which supplies are required.
  • Product name and description.
  • Anticipated frequency of replacing the supplies.
  • Quantity.

Incontinence supplies are limited to the items listed above up to $165 per month. Incontinence creams and washes are not subject to the $165 per month limit and are available for members ages 21 and older.

For more information about incontinence medical supply coverage, refer to the Department of Health Care Services (DHCS) Medi-Cal Provider Manual.

Medi-Cal Only

Health Net does not provide benefits for incontinence supplies for Medi-Cal members younger than age five. Benefits are provided only if the incontinence is due to a chronic physical or mental condition, including cerebral palsy and developmental delay, at an age when the child would normally be expected to achieve continence. Incontinence creams and wash products are covered under Medi-Cal.

Last Updated: 04/08/2021