Bowel Management Devices - DME.SU.101.A

Durable bed pans (HCPCS E0275, E0276) and the Peristeen transanal irrigation system (HCPCS A4459, A4453) are covered; single‑use/non‑durable hygiene items (e.g., disposable sheets/bags A4335, underpads A4554/A4553), incontinence garments (A4520), rectal inserts (A4337), gravity enema systems (A4458), pulsed irrigation systems (E0350/E0352) are excluded and microprocessor electrical continence aids are investigational. Coverage requires documentation that the patient is confined to bed for bed pans, that Peristeen is for chronic neurogenic bowel after failure of diet, bowel‑habit modification and laxatives/constipating medications, that devices meet durability requirements, and correct HCPCS codes must be used.

"A bed pan (HCPCS E0275, E0276) may be considered medically necessary for an individual who is confined to a bed."

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