WASHINGTON—The Durable Medical Equipment Medicare Administrative Contractors (DME MACs) have published a final local coverage determination (LCD) for urological supplies that broadens access for people with spinal cord injuries.
In the new LCD, Medicare added spinal cord injury (SCI) as a qualifying condition for access to sterile intermittent catheter kits. In fact, the revised LCD went beyond the proposal and clarified coverage to allow for SCI at any level—a move praised by industry advocates.
"Of particular importance to suppliers, the accompanying policy article clarifies that documentation of an SCI diagnosis alone is sufficient to establish that a beneficiary is immunocompromised for the purposes of qualifying for sterile catheter kits (A4297, A4353)," AAHomecare said in an email to members about the new LCD. "The clarification streamlines coverage by allowing documentation of SCI alone to automatically qualify a beneficiary as immunocompromised for sterile catheter kits, allowing patients access to sterile kits without requiring them to have two urinary tract infections (UTIs)."
The new LCD also incorporates the new and revised health care common procedure coding system (HCPCS) codes for intermittent catheters, including separate codes for hydrophilic catheters. These changes take effect Thursday, Jan. 1, 2026.
AAHomecare thanked the Intermittent Catheter Coding Reform Coalition (ICCRC) for its collaborative approach and continued advocacy to improve coverage for patients, and also thanks the DME MACs for the expanded coverage that aligns with current clinical evidence saying it is an important step in reducing serious urinary tract infections.
For more information click on the links below:
Final LCD: Urological Supplies (L33803)
Policy Article: Urological Supplies (A52521)