Updated Medicare Rules Expand Access to Urological Supplies for SCI Patients

The DME MAC contractors have issued a finalized Local Coverage Determination (LCD) for urological supplies, effective January 1, 2026. The update integrates revisions based on stakeholder comments and provides an important clarification for patients with spinal cord injury (SCI). According to CMS, documentation of SCI in a patient’s medical record is now sufficient to qualify for sterile catheter kits, without requiring proof of recurrent urinary tract infections. The LCD explains that SCI not only causes motor and sensory loss but also disrupts autonomic and immune function, leading to SCI-induced immune deficiency and a higher risk of infection. Evidence shows that immune suppression occurs across all spinal levels and severities. AAHomecare emphasized that the clarification simplifies coverage by automatically recognizing SCI patients as immunocompromised for catheter supply eligibility. Additionally, the LCD introduces new HCPCS codes for hydrophilic catheters—A4295, A4296, and A4297—also effective January 1, 2026.