External urinary and/or fecal collection system for home use
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Defines HUSKY Health coverage and prior authorization guidance for external urine and/or fecal collection systems (home-use suction-based devices) for Connecticut Medicaid enrollees, and explains the medical necessity stance and review procedures for providers.
No material clinical or coverage changes in this revision.
Coverage Determination & Criteria
General coverage determination
Coverage determination summary:
EPSDT may require coverage for beneficiaries under age 21 if medically necessary
The use of an external urinary and/or fecal collection system in a home setting is considered investigational and therefore not medically necessary. This determination is based on insufficient evidence from peer-reviewed published literature demonstrating clinical efficacy and safety for management of urinary or fecal incontinence in the home setting.
Coverage determinations are individualized and made in accordance with the DSS definition of Medical Necessity. For home use, current literature does not substantiate improved health outcomes or medical benefit for external urinary and/or fecal collection systems; therefore home use remains considered investigational and not medically necessary. Authorization decisions will be based on an assessment of the individual’s unique clinical needs and submitted medical documentation.
DME medical necessity guidance — policy position and EPSDT note
Policy position and EPSDT note:
Requests still require submission of case-specific documentation for review.
Coding and Billing Codes
| E2001 | E2001 Suction pump, home model, portable or stationary, electric, any type, for use with external urine and/or fecal management system |
Provider Actions & Prior Authorization
Prior authorization required (effective 11/01/2025)
Prior authorization is required for requests for an external urinary and/or fecal collection system for individuals covered under HUSKY A, B, C, and D beginning November 1, 2025; review is based on medical necessity and submitted case‑specific documentation.
- Effective date: November 1, 2025
- Affected plans: HUSKY A, B, C, and D
- Review basis: medical necessity and submitted case-specific information
Submit case-specific clinical documentation
Submit supporting case-specific clinical information demonstrating medical necessity; requests will be reviewed under the DME prior authorization procedures and coverage determinations are individualized based on the member’s clinical needs.
- Provide detailed clinical rationale and documentation with the PA request
- Coverage determinations follow the DSS definition of Medical Necessity and are individualized
Submission and review follow DME prior authorization procedures
Requests for coverage will be reviewed in accordance with existing procedures for reviewing durable medical equipment prior authorization requests and evaluated based on the submitted case‑specific information.
- Follow standard DME prior authorization submission and review workflows
- Include all supporting medical records and justification for home use
Investigational — denial risk for home use requests
Coverage requests for home use of external urinary and/or fecal collection systems are considered investigational and therefore not medically necessary due to insufficient peer‑reviewed evidence; such requests may be denied if medical necessity is not established.
- Policy states home use is investigational and not medically necessary
- EPSDT may require coverage for beneficiaries under age 21 if medically necessary (coverage determinations remain individualized)
Definitions
Background & Device Description
External urine collection systems (examples include PureWick® and QIVI®) are external, suction‑based devices that wick urine away from the perineal area into a sealed canister. Combined external urine and fecal collection systems (for example, the Curaco Carebidet) use sensors and suction to remove excreta and may provide perianal cleansing and drying cycles. HUSKY Health finds the available peer‑reviewed evidence insufficient to support their efficacy and safety for use in the home setting.
Rental / Purchase Coding Rules
| Item | HCPCS / Description | Coverage stance |
|---|---|---|
| Suction pump | E2001 — Suction pump, home model, portable or stationary, electric, any type, for use with external urine and/or fecal management system | Not covered for home use (investigational) — prior authorization required for review of medical necessity; EPSDT may apply for beneficiaries under age 21 |
| Rental / Purchase rules | Requests reviewed under DME procedures; HCPCS code E2001 identifies the suction pump used with these systems | Neutral (billing code specified; clinical coverage stance is investigational for home use) |
Documentation Requirements
Submit supporting medical documentation for review
Submit case-specific clinical documentation to demonstrate medical necessity; coverage determinations will be based upon review of the requested and/or submitted information.
- Provide detailed clinical rationale showing medical necessity for the individual
- Include relevant medical records and assessments used to justify the request
Not Covered Items
External urinary and/or fecal collection systems intended for use in the home setting are not covered because they are considered investigational and not medically necessary.
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