CMS Update: TAI Devices

The Centers for Medicare and Medicaid Services (CMS) has published a positive Benefit Category Determination (BCD) for Transanal Irrigation devices, catheters and accessories (TAI).

TAI Classification Updates

We are pleased to inform you of a significant update from the Centers for Medicare & Medicaid Services (CMS) regarding Transanal Irrigation (TAI) devices.

 

CMS now classifies certain TAI devices—including those with balloon - or cone-based catheters—as prosthetic devices. This update is effective as of April 1st, 2025, and is expected to lead to more consistent coverage and reimbursement for eligible patients.

Revised Codes & Payment Determination

HCPCS Codes

Revised HCPCS Codes include the following:

A4459: Now specifically defined as “Manual transanal irrigation system” for units without catheters.

A4453: Assigned for Rectal Catheter or Cone.

These changes differentiate TAI from traditional enema systems, streamlining billing and coding processes.

Payment Determination

While a national payment rate is still being finalized by CMS, local DME MACs will set fee schedules in the interim. This provides an immediate path to reimbursement until a uniform national rate is established.

Opportunities for Your Practice

Growing Demand

There is an increasing need for effective solutions among patients with neurogenic bowel dysfunction or chronic constipation. TAI has demonstrated a strong clinical record in enhancing quality of life.

Stable Reimbursement

With TAI’s new classification, reimbursement is expected to become more predictable and stable.

Practice Differentiation

Offering TAI not only meets a growing patient need but also positions your practice as a leader in innovative, patient-focused therapies.

 

Please contact your local Wellspect representative for more information 

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