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T4521 - Inappropriately Requiring Prior Approval

HFS System Issue:

T4521 is denying R09, Requires Prior Approval, inappropriately.


On or about 7/21/14, a system change request was made for T4521 that did not affect pricing. When the requested change was made, the system was inadvertently changed to put the code, T4521, on prior approval.

Providers Impacted:

Durable Medical Equipment and Supplies Providers

Procedure Codes Impacted:

T4521, Adult sized disposable incontinence product, brief/diaper, small, each

Problem Begin Date:

Claims with dates of service on or about 7/21/14

Problem Fix Date:


Resolution for Impacted Claims:

Providers must rebill.

Claims Processing System Issues

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Illinois Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director