CommercialCoverageMedium impact
Bulking Agents for Treatment of Urinary or Fecal Incontinence 7.01.22
Excellus BlueCross BlueShield·Urology, OB-GYN·Urinary System (Genitourinary)
Effective date
Mar 19, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their policy on bulking agents for urinary and fecal incontinence, effective March 19, 2026. The policy specifies medical necessity criteria for FDA-approved urethral bulking agents including collagen implants and various bulking agents (Durasphere, Bulkamid, Coaptite, Macroplastique) for treating stress incontinence due to intrinsic sphincter deficiency in specific patient populations. Perianal bulking agents for fecal incontinence remain investigational.
Action Required
Before March 19, 2026: Billing team must review claims for urethral bulking agents to ensure they meet the specific medical necessity criteria outlined in the policy. Verify patients have stress incontinence due to intrinsic sphincter deficiency, document failure of conservative therapy, and confirm use of FDA-approved bulking agents (Durasphere, Bulkamid, Coaptite, Macroplastique) only. For Durasphere, limit to 5 injection sessions maximum. Deny coverage for investigational agents like Teflon or autologous cellular therapy.