DMEMACs clarify coverage for caths
By HME News Staff
Updated 10:31 AM CST, Tue December 5, 2023
WASHINGTON – Both CGS and Noridian have clarified that a high-level spinal cord injury (T3 and above) is an example of immunosuppression, meeting criteria #2 for coverage for closed-system catheters, Coloplast has announced. In October 2021, during a DME MAC council call, it was stated, “The example of high-level spinal cord injury patients (higher than T3) will be considered for coverage when conducting medical reviews of intermittent catheterization using a sterile intermittent catheter kit (A4353),” but this created confusion because it was not one of the examples listed in Urological LCD 33803. The LCD outlines coverage requirements for intermittent catheters (A4351, A4352 and A4353), including five criteria for A4353, of which a beneficiary must meet one to qualify for a closed-system catheter. For criteria #2, immunosuppression, it lists examples of conditions that commonly cause immunosuppression and states the list is not all-inclusive. Because of inconsistencies, stakeholders reached out to CGS and Noridian.
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