How Peristeen® Plus works

Water is introduced into the rectum and colon via the anus and subsequently evacuated into a toilet together with the contents of the descending colon, sigmoid and rectum.

Who can use Peristeen® Plus

Peristeen® Plus is an FDA approved device indicated for use by children (2 years -<12 years), adolescents (12 years - < 18 years transitional adolescents (18 years - <21 years) and adult patients with neurogenic bowel dysfunction (NBD) who suffer from fecal incontinence, chronic constipation and/or time-consuming bowel management procedures.

TAI is considered when first line treatments fail to provide sufficient relief from symptoms of fecal incontinence or constipation

A stepwise approach to treating neurogenic bowel dysfunction, building from more conservative first-line interventions to second-line treatments like Peristeen and finally to invasive surgical treatments, including stoma surgery.

Medicare covers Peristeen® Plus as of April 1, 2025

The Centers for Medicaid and Medicare Services (CMS) issued a positive final Benefit Category Determination (BCD)¹ for transanal irrigation (TAI) devices and accessories.  Effective April 1, 2025, devices with rectal catheters with a sealing function (e.g., balloon or cone-based catheters) are considered “prosthetic devices.” In addition, the Bowel Management Devices Local Coverage Determination (LCD) L36267² was updated to remove previous non-coverage language for manual pump systems. 

The Bowel Management Devices-Policy Article (A54516)³ outlines coding and billing guidelines for Peristeen Plus. For Medicare beneficiaries, individual coverage of Peristeen Plus is based on medical necessity. Documentation in the medical record must reflect the medical need for transanal irrigation.  

Revisions¹ to the existing HCPCS Level II codes, effective April 1, 2025, as well as final Medicare reimbursement,⁴ effective October 1, 2025, are below.

Learn more: Peristeen Plus Medicare Update

Understanding Medicare Reimbursement and Coverage: 

Medicare Coverage: Peristeen Plus is covered under Medicare Part B.  

Medicare Deductible: Medicare beneficiaries have a yearly deductible that must be met before Medicare pays any claims.⁴ 

Medicare Out of Pocket Costs: After the deductible is met, Medicare beneficiaries have a 20% coinsurance responsibility. ⁴ Beneficiaries with supplemental insurance may incur less out of pocket cost. DME providers may be able to provide a patient out of pocket cost estimate. 

Medicare Advantage Coverage: Medicare Advantage plans must cover all medically necessary services that Original Medicare covers.⁵ 

Medicare Advantage Deductible: Medicare Advantage beneficiaries may have a yearly deductible that must be met before the Medicare Advantage plan pays any claims. 

Medicare Advantage Out of Pocket Costs: Reimbursement and beneficiary out of pocket costs varies and is dependent on the supplier’s contract with the Medicare Advantage health plan. DME providers may be able to provide a patient out of pocket cost estimate. 

Prepare your Clinic Coloplast is available to clinically train your team on transanal irrigation with Peristeen Plus today! Contact your local Territory Manager to schedule a training.

Medicaid Information Overview

Each state Medicaid program maintains its own fee schedule for Durable Medical Equipment (DME), which outlines the reimbursement rates for items like transanal irrigation system (TAI). These fee schedules vary widely by state and are updated periodically to reflect changes in policy, pricing, and medical necessity

Rather than administering all benefits directly, most states contract with Managed Care Organizations (MCOs) to deliver Medicaid services, including DME. This model is known as Managed Medicaid.

Managed Medicaid plans are private health plans that operate under contract with state Medicaid agencies. These contracts require MCOs to:

• Build provider networks
• Handle prior authorizations and utilization management
• Coordinate care for enrollees
• Ensure access to covered services, including DME

States individually contract with these plans, often through competitive procurement processes. These contracts are reviewed by the Centers for Medicare & Medicaid Services (CMS) to ensure compliance with federal regulations

Managed Medicaid coverage and reimbursement

• Follows Medicaid coverage and can provide additional benefits
• Reimbursement can be different than Medicaid
• Managed Medicaid plan contract with suppliers at rates typically discounted from Medicaid fee schedule
• DME Suppliers need to contract with each plan

Commercial coverage and reimbursement

• Broad commercial coverage with national and regional payors