T4540 Reusable underpad chair sizeIncontinence product, protective underpad, reusable, chair size, each
Status N: non-covered service.
1 of 1 payer prior-auth lists that name T4540 require prior authorization or set conditions: Passport by Molina Healthcare (Kentucky).
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth under conditions | State exception; PA above quantity limits | Jul 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 |
T4540 appears in 2 coverage policies from Aetna, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Urological Supplies (0533) | not covered | Jul 30, 2026 | payer document |
| Premera Blue Cross | Non-covered Services and Procedures Page | 23 of 30 | ∞ | not covered | Jun 1, 2026 | payer document |
Prior authorization required or conditional in KY, MA, NY, OH, VA.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.