WASHINGTON, D.C. – Earlier this month, Noridian published an article stating that high-level spinal cord injuries (T3 or higher) will be considered for coverage during medical reviews.
The criteria are added to the current LCD language. Immunosuppressed criteria for the A4353 (intermittent urinary catheter, with insertion supplies) are covered when a beneficiary requires catheterization and the beneficiary is immunosuppressed, for example (not an inclusive list):
• on a regimen of immunosuppressive drugs post-transplant;
• on cancer chemotherapy;
• has AIDS;
• has a drug-induced state such as chronic oral corticosteroid use; and
• high-level spinal cord injury patients (T3 and higher) will be considered for coverage when conducting medical reviews.
It is important to note that the provided list is not exhaustive, and practitioners must clearly document the condition causing immunosuppression in the beneficiary’s medical records to qualify for the criteria. These records must align with the medical necessity outlined in the Local Coverage Determination (LCD) L33803.
AAHomecare received confirmation the LCD will be updated. AAHomecare thanks the DME MACs for addressing this long-standing request from the clinical community and suppliers.