Irrigation Supply Sleeves - Correct Coding

Joint DME MAC and PDAC Publication

Effective for dates of service on or after January 1, 2022, the Centers for Medicare & Medicaid Service (CMS) discontinued HCPCS code A4397 (IRRIGATION SUPPLY; SLEEVE, EACH) and created two new HCPCS codes, A4436 and A4437: 

A4436 IRRIGATION SUPPLY; SLEEVE, REUSABLE, PER MONTH

A4437 IRRIGATION SUPPLY; SLEEVE, DISPOSABLE, PER MONTH

New HCPCS codes A4436 and A4437 were created to differentiate between irrigation sleeves that are reusable, and those that are for single use. 

Reusable irrigation sleeves, described by A4436, are secured around the stoma using a belt or by locking onto a faceplate that is attached to the peristomal skin. They are typically used for a week or more, cleaned and dried between irrigations, before finally being discarded.

Disposable irrigation sleeves, described by A4437, have an adhesive component that is applied directly onto the peristomal skin, and need to be discarded after each irrigation due to inability to re-adhere to the skin surface. 

When submitting an irrigation sleeve to the PDAC for code verification it is important to provide documentation and/or evidence showing how the sleeve is secured, and how often it can be used.

For questions about correct coding, contact the PDAC HCPCS Helpline at (877) 735-1326 during the hours of 9:30 am to 5:00 pm ET, Monday through Friday. You may also visit the PDAC website to chat with a representative, or select the Contact Us button at the top of the PDAC website for email, FAX, or postal mail information.