Currentpriority healthPolicy N/A

Bowel management device billing and coding

Defines billing, coding, documentation, place of service and reimbursement guidance for bowel management devices (Peristeen trans anal irrigation system) for Priority Health providers; affects billing providers submitting claims for these devices and related supplies.

Policy Summary

Payerpriority health

PolicyBowel management device billing and coding

Policy CodePolicy N/A

Change TypeNew policy

Effective DateNov 17, 2025

Next Review DateN/A

Key ActionObtain Pre-Service Organization Determination (PSOD) for Medicare indications that do not meet NCD/LCD or specific medical policy and when authorization is required by place of service or patient condition.

SourceLink

POLICY UPDATE CHANGES

New policy created for bowel management device billing and coding.

1HCPCS primary all-inclusive code listed (A4459)

1HCPCS code for refillable rectal catheters (A4453)

Apr 1, 2025coding instruction effective

Nov 17, 2025policy effective date

Coverage Overview and Requirements

Coverage overview and requirements

Coverage is considered when services are furnished in an appropriate setting based on the patient’s medical needs; authorization and medical necessity requirements apply. CMS/MDHHS guidance applies when specified.

Services must be furnished in an appropriate place of service based on the patient’s medical needs and condition (Place of Service).

Authorization may be required prior to provision of the device or related services when specified by the member’s benefit plan or place of service.

Medical necessity, appropriate procedure/diagnosis, and frequency requirements must be met and documented in the medical record.

CMS and MDHHS guidelines apply unless otherwise specified in this policy; where such guidance is absent, this policy applies.

Policy Summary

Payerpriority health

PolicyBowel management device billing and coding

Policy CodePolicy N/A

Change TypeNew policy

Effective DateNov 17, 2025

Next Review DateN/A

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Peristeen Bowel Management Device Coding

Peristeen bowel management device codesHCPCSCovered

A4459	Peristeen trans anal irrigation system – all-inclusive code (do not bill components separately prior to April 1, 2025 and continued to present)
A4453	Refillable rectal catheters

Time-based coding change (Peristeen bowel management device)

Jan 2015 – Mar 2025 coding instructionUse HCPCS A4459 as an all-inclusive code (do not bill components separately); use HCPCS A4453 for refillable rectal catheters.

Apr 1, 2025 – present coding instructionUse HCPCS A4459 and A4453.

Primary HCPCS codesA4459 (Peristeen trans anal irrigation system — all-inclusive); A4453 (refillable rectal catheters).

Authorization and Pre-Service Determination

Prior Authorization

Prior Authorization / PSOD Required for Medicare

For Medicare: When the indication does not meet an applicable National Coverage Determination (NCD), local Coverage Determination (LCD), or a specific Priority Health medical policy, a Pre‑Service Organization Determination (PSOD) must be completed prior to providing the service. Providers should submit a PSOD to request a coverage determination for Medicare members. Click here for additional details on PSOD.

Place of Service: Coverage will be considered for services furnished in the appropriate setting to the patient’s medical needs and condition. Authorization may be required. Click here for additional information.

OpenPayer

Bowel management device billing and coding

Coverage Overview and Requirements

Peristeen Bowel Management Device Coding

Authorization and Pre-Service Determination

Key Definitions