| T4521 | Adult sized disposable incontinence product, brief/diaper, small, each |
| T4522 | Adult sized disposable incontinence product, brief/diaper, medium, each |
| T4523 | Adult sized disposable incontinence product, brief/diaper, large, each |
| T4529 | Pediatric sized disposable incontinence product, brief/diaper, small/medium size, each |
| T4524 | Adult sized disposable incontinence product, brief/diaper, extra large, each |
| T4543 | Adult sized disposable incontinence product, protective brief/diaper, above extra large, each |
| T4544 | Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
| T4528 | Adult sized disposable incontinence product, protective underwear/pull-on, extra large size, each |
| T4527 | Adult sized disposable incontinence product, protective underwear/pull-on, large size, each |
| T4526 | Adult sized disposable incontinence product, protective underwear/pull-on, medium size, each |
| T4525 | Adult sized disposable incontinence product, protective underwear/pull-on, small size, each |
| T4534 | Youth sized disposable incontinence product, protective underwear/pull-on, each |
| T4530 | Pediatric sized disposable incontinence product, brief/diaper, large size, each |
| T4531 | Pediatric sized disposable incontinence product, protective underwear/pull-on, small/medium size, each |
| T4532 | Pediatric sized disposable incontinence product, protective underwear/pull-on, large size, each |
| E1220 | Wheelchair; specially sized or constructed, (indicate brand name, model number, if any) and justification |
