A Centers for Medicare & Medicaid Services (CMS) policy change is opening the door to reimbursement for transanal irrigation devices (TAI), catheters and accessories.
As reported by United Spinal Association on Feb. 13, CMS published a positive Benefit Category Determination for TAI, catheters and accessories on Jan. 13. In that Benefit Category Determination, United Spinal said CMS indicated that it now considers this equipment to be a prosthetic device “that replaces all or part of an internal body organ (in this case, bowel), meaning that CMS should next provide coverage and payment for these devices for individuals in need.”
United Spinal added, “All TAI systems that have a sealing function (rectal balloon or cone-shaped catheters) are now classified as prosthetic devices by CMS. CMS’s updated TAI coding definitions are effective April 1, 2025. It will take Medicare some time to finalize coverage criteria and reimbursement amounts; however, billing will be effective April 1. CMS is expected to establish a publicly available payment amount October 1, 2025, or later.”
“This is exciting news because TAI gives eligible people an important tool for neurogenic bowel management,” says Alexandra Bennewith, VP of government relations for United Spinal. Bennewith added that United Spinal’s Access & Care Coalition, Coloplast, Wellspect, and the Spina Bifida Association worked together to meet with CMS and members of Congress “where advocates explained how their lives had been impacted with or without access to TAI. Advocates’ stories and their lived experiences are always so powerful, and our policy makers always need to hear from us.”
Neurogenic bowel dysfunction can “occur in the majority of patients with chronic neurological disease, like multiple sclerosis, spinal cord injury, and Parkinson’s disease,” the National Library of Medicine (NLM) reported.
“Neurologic injury or disease impairs the brain and the bowels from functioning together, resulting in the inability of the bowel to function in a typical fashion,” United Spinal said in a position paper on bowel management.
Symptoms include constipation, fecal incontinence, urinary tract infections, urinary incontinence, skin breakdown and pressure injuries, leading to frequent emergency department visits, United Spinal added. When “conservative management” — including diet changes and laxatives — aren’t adequate to manage symptoms, “transanal irrigation has been shown to reduce neurogenic bowel dysfunction symptoms and improve quality of life,” the NLM said.
The NLM added that about half of patients with neurogenic bowel dysfunction are not able to manage their symptoms by changing their diet and using laxatives, making transanal irrigation the next step in managing the disorder.
