Bowel Management Devices - Policy Article

Medicare covers prosthetic bowel management devices (rectal inserts, electrical continence aids, and TAI systems with a sealing catheter) under the Prosthetic Devices benefit and durable bed pans under the DME benefit when applicable reasonable-and-necessary and LCD documentation requirements are met. Many disposable, non-durable, or institutional bowel-management items (e.g., disposable sheets/bags, incontinence pads, gravity enema systems, fecal collection systems, PIE devices, and disposable bed pans) are statutorily excluded or non-covered; Final Rule 1713 requires a face-to-face encounter and Written Order Prior to Delivery for specified HCPCS codes and failure to comply will result in claim denial.

"Rectal inserts (HCPCS A4337) are covered under the Prosthetic Devices benefit when reasonable and necessary (R&N) requirements in the applicable LCD are met."