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Incontinence PULL-UPS

  • All incontinence orders require Prior Authorization through Title 19.
  • Our staff will gather the necessary paperwork for Prior Authorization.
  • If Title 19 denies the requested order, we will contact the Case Manager to submit the order to Advantage Waiver for approval.
  • You’ll receive updates in Harmony on our progress.
  • For additional quantities, the case manager will add the overage to the member’s Advantage service plan.
TITLE 19 QUANTITY LIMIT: 150
We Also Carry Tena & Attends Products
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HCPCS: T4525

PV511

Moderate

Small (20” to 34”) | Pack of 22

Medicaid/Title 19: $0.86 Each

Advantage: $0.86 Each

HCPCS: T4526

PF512

Moderate

Medium (34” to 46”) | Pack of 20

Medicaid/Title 19: $1.01 Each

Advantage: $1.01 Each

HCPCS: T4526

PVS512

Super

Medium (34” to 46”) | Pack of 18

Medicaid/Title 19: $1.01 Each

Advantage: $1.01 Each

HCPCS: T4527

PVS513

Super

Large (44” to 54”) | Pack of 16 ($ 1.10 Each.)

Medicaid/Title 19: $1.10 Each

Advantage: $1.10 Each

HCPCS: T4528

PF514

Moderate

XLarge (48” to 68”) | Pack of 14 ($ 1.25 Each.)

Medicaid/Title 19: $1.25 Each

Advantage: $1.25 Each

HCPCS: T4544

PV517

Bariatric Super

XXL (68” to 80”) | Pack of 12 ($ 2.02 Each)

Medicaid/Title 19: *Manually Priced

Advantage: $2.25 Each

Incontinence PADS

  • All incontinence orders require Prior Authorization through Title 19.
  • Our staff will gather the necessary paperwork for Prior Authorization.
  • If Title 19 denies the requested order, we will contact the Case Manager to submit the order to Advantage Waiver for approval.
  • You’ll receive updates in Harmony on our progress.
  • For additional quantities, the case manager will add the overage to the member’s Advantage service plan.
TITLE 19 QUANTITY LIMIT: 150
We Also Carry Tena & Attends Products
Need FREE Member Samples - CALL NOW
HARMONY Log-In

HCPCS: T4535

PV930

First Quality Pads

Light (9.25” Length) | Pack of 30 ($ 0.59 Each)

Medicaid/Title 19: $0.59 Each

Advantage: $0.59 Each

HCPCS: T4535

BC012

First Quality Pads

Regular (9.25” Length) | Pack of 20 ($ 0.59 Each)

Medicaid/Title 19: $0.59 Each

Advantage: $0.59 Each

HCPCS: T4535

19564

Poise Pads

Moderate (3.0” X 9.5”) | Pack of 20 ($ 0.59 Each)

Medicaid/Title 19: $0.59 Each

Advantage: $0.59 Each

HCPCS: T4535

BC013

First Quality Pads

Moderate (4.0” X 11.00”) | Pack of 16 ($ 0.59 Each)

Medicaid/Title 19: $0.59 Each

Advantage: $0.59 Each

HCPCS: T4535

PV811

MALE Incontinent Pads

Moderate (13” long ) | Pack of 14 ($ 0.59 Each)

Medicaid/Title 19: $0.59 Each

Advantage: $0.59 Each

HCPCS: T4535

PV9231

First Quality Pads

Super 16” length) | Pack of 33 ($ 0.59 Each)

Medicaid/Title 19: $0.59 Each

Advantage: $0.59 Each

HCPCS: T4535

1711310

Belted Undergarment One Size

Pack of 10 ($ 0.59 ea.)

Medicaid/Title 19: $0.59 EA

Advantage: $0.59 EA

Incontinence BRIEFS

We Also Carry Tena & Attends Products
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HCPCS: T4522

PF012BG

Moderate

Medium (32” to 44”) | Pack of 20 ($ 0.85 ea)

Medicaid/Title 19: $0.85 Each

Advantage: $0.85 Each

HCPCS: T4523

NUFIT013

Moderate

Large (45” to 58”) | Pack of 18 ($ 0.96 ea)

Medicaid/Title 19: $0.96 Each

Advantage: $0.96 Each

HCPCS: T4523

0132BG

Moderate

Large (45” to 58”) | Pack of 18 ($ 0.96 ea)

Medicaid/Title 19: $0.96 Each

Advantage: $0.96 Each

HCPCS: T4524

PF0141BG

Moderate

XLarge (59” to 64”) | Pack of 15 ($ 1.13 ea)

Medicaid/Title 19: $1.13 Each

Advantage: $1.13 Each

HCPCS: T4543

PV017

Moderate

XXLarge (62” to 73”) - Size A | Pack of 12 ($ 2.02)

Medicaid/Title 19: Manually Priced

Advantage: $2.25 Each

HCPCS: T4543

PV097

Bariatric Moderate

XXXLarge (Up to 94”) - Size B | Pack of 10 ($ 2.25)

Medicaid/Title 19: Manually Priced

Advantage: $2.25 Each

Incontinence UNDERPADS

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HCPCS: T4542

UP150

Disposable Underpad 23 X 36”

Pack of 15 ($ 0.38 ea)

Medicaid/Title 19: $.038EA

Advantage: $.038 EA

HCPCS: T2028

988B12

Breathable Underpads 30’ x 30’

Pack of 12 988B6

Medicaid/Title 19: $1.50 Each

Advantage: $1.50 Each

HCPCS: T4541

UP100

Disposable Underpad 30” X 30”

Pack of 10 ($ 0.58 ea)

Medicaid/Title 19: $0.58 EA

Advantage: $0.58 EA

HCPCS: T4541

UFPP360

Disposable Underpad 30” X 36”

Pack of 10 ($ 0.58 ea)

Medicaid/Title 19: $0.58 EA

Advantage: $0.58 EA

HCPCS: T4540

71188600

Chair Size Washable Underpads

18” X 24” (each)

Medicaid/Title 19: $14.40 Each

Advantage: $14.40 Each

HCPCS: T4537

63178601

Washable Underpad

34” X 35” (each)

Medicaid/Title 19: $13.50 Each

Advantage: $13.50 Each

BATHROOM SAFETY

HCPCS: S5165: TF

Hand Held Shower, Installed

$90.00 EACH

Use a TF Modifer

HCPCS: S5165: TF

Raised Toilet Seat Without Arms, 250 lbs. Capacity

$80.00 EACH

Use a TF Modifier

HCPCS: S5165: TF

Raised Toilet Seat With Arms, 250 lbs. Capacity

$100.00 EACH

Use a TF Modifer

HCPCS: S5165: TF

Toilet Safety Frame, 250 lbs. Capacity

$90.00 EACH

Use a TF Modifer

HCPCS: E0240

Shower Chair Without Back

Seat Dimensions: 19.25" (W) x 11.5" (D)

Weight Capacity: 300 lb.

Medicaid/Title 19: $70.00 EACH
Needs: RX, Medical Records & PA

HCPCS: E0240

Shower Chair With Back

Seat Dimensions: 19.25" (W) x 11.5" (D)

Weight Capacity: 300 lbs

Medicaid/Title 19: $75.00 EACH
Needs: RX, Medical Records & PA

HCPCS: E0240

Heavy Duty Shower Chair Without Back

Seat Dimensions: 20" (W) x 12” (D)

Seat To Floor Height: 14"-19"

Weight Capacity: 500 lbs

Medicaid/Title 19: $95.00 EACH
Needs: RX, Medical Records & PA

HCPCS: E0240

Heavy Duty Shower Chair With Back

Seat Dimensions: 20” (W) x 12” (D)

Seat Height: 14 Inch - 19 Inch

Weight Capacity: 500 lbs

Medicaid/Title 19: $125.00 EACH
Needs: RX, Medical Records & PA

HCPCS: E0247

Tub Transfer Bench

Seat Dimensions: 26" (W) x 18.5" - 19.5" (D)

Weight Capacity: 400 lb.

Medicaid/Title 19: $125.00 EACH
Needs: RX, Medical Records & PA

HCPCS: E0248

Heavy Duty Tub Transfer Bench

Seat Dimensions: 26.5" (W) x 16.5" (D)

Weight Capacity: 500 lb

Medicaid/Title 19: $160.00 EACH
Needs: RX, Medical Records & PA

HCPCS: S5165: TF

Bathtub Mounted Grab Bar

Weight Capacity: 300 lbs.

$75.00 EACH

Use a TF Modifer

HCPCS: S5165: TF

Grab Bar Wall Mount, 350 lbs. Capacity, Installed

Sizes; 12”, 16”, 18”, 24”, 32”

$150.00 EACH

Use a TF Modifer

AIDS TO DAILY LIVING

HCPCS: A4663

Blood Pressure Monitor

$60.00

HCPCS: T1505

Automatic Alarmed Pill Dispenser

$125.00

HCPCS: E0274

Overbed Table

Medicaid/Title 19: $150.00

HCPCS: E0705

Transfer Device - Gait Belt

Medicaid/Title 19: $28.50

HCPCS: A4927

  • Gloves (only with incontinence order)
  • Two Boxes Per Month May be Authorized for those receiving PCA Services
  • Needs: RX, Medical Records.
  • PA Required
  • Advantage: $10.00

HCPCS: E1399

  • Adaptive Utensils – Universal Size & Set
  • (Curved and Weighted available)
  • Needs: RX, Medical Records.
  • No PA Required
  • Advantage: $68.00

HCPCS: A9281

  • Hip Kit – Includes: 32” or 26”
  • Reacher, sock aid w/ foam handle, plastic 16 1/4” shoehorn, bendable 18” handled bathing sponge.
  • Needs: RX, Medical Records.
  • No PA Required
  • Advantage: $62.50

HCPCS: A9281

  • Comfort Hygiene Wipe
  • Needs: RX, Medical Records.
  • No PA Required
  • Advantage: $28.00

HCPCS: A9281

Sock Aid

Needs: RX, Medical Records. No PA Required

Advantage: $24.50

HCPCS: A9281

Reacher - 26” or 32”

Needs: RX, Medical Records. No PA Required

Advantage: $35.00

PERSONAL EMERGENCY RESPONSE SYSTEM

  • iMed Alert Systems must be chosen for this item.
  • Service Plan Provider must be listed as iMed Alert Systems.
  • Please tag all Harmony Notes to Evan McCown.
  • All units are GPS enabled!
  • These units can be used anywhere your member goes!
  • Find out how to get a Personal Emergency Response System approved for your members safety

HCPCS: S5161: $35/Month Activation Fee: HCPCS S5160: $50.00

Belle LTE Pendant
30 Day Battery Life
Verizon 4G LTE
Water Resistant (IP67)
WiFi/Cellular Location Tracking

HCPCS: S5161: $35/Month Activation Fee: HCPCS S5160: $50.00

Brighton Smart Watch
24 Hour Battery Life
AT&T 4G LTE
Water Resistant (IP67)
GPS/WiFi Location Tracking
Fall Detection optional
Monitors Heart Rate, Steps, & Weather

HCPCS: E1399

Lock Box/Key Safe
Advantage: $25.00

HCPCS: S5161

GPS Cellular Unit /Monthly Monitoring
Advantage: $35.00

HCPCS: S5161: $35/Month Activation Fee: HCPCS S5160: $50.00

Belle W Wristband
6 Day Battery Life Verizon 4G LTE
Water Resistant (IP67)
WiFi Location Tracking
Fall Detection Optional
Battery Life: 45 Days

What To Expect With Your Order!

  • A trained technician contacts the member to gather essential information for proper programming of the iMed Alert System.
  • We work with our monitoring company to test, charge, and prepare each unit for immediate use.
  • Once ready, the device is shipped directly to the member. NOTE: Modern GPS-enabled units require no invasive installation, unlike older 3G models.
  • Upon delivery, the member is instructed to contact us for a walkthrough on charging, testing, and operating their device.
*NOTE: Products may vary from the images above based on current availability.