Medicare covers catheters and related medical supplies that a doctor says is medically necessary. Coverage depends on the type of catheter and the medical reason for it. The type of facility may also determine what supplies are covered. Supplies covered by Medicare may also include catheter supplies like irrigation kits, bedside drain bags, leg bags, irrigation syringes, and extension tubing.
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Medicare Catheter Coverage
Some conditions that may need the use of a catheter include urinary incontinence, prostate or genital surgery, spinal cord injury, and urinary retention. Diseases like multiple sclerosis, dementia, and others can cause complications with urinating.
The health condition of a person determines if the use or need is either short or long term. Under certain circumstances, catheters may only be necessary for a short time. Like, during a medical procedure or while staying in the hospital. For some, the bladder function and/or muscles for controlling urination stop working properly. This may require long-term catheter use.
What Types of Catheters Does Medicare Cover?
Medicare covers many types and styles of urinary catheters. Patients with permanent or temporary (conditions last 3+ months) urinary incontinence or urinary retention can receive coverage for catheters.
Indwelling Catheter
These are available for both men and women. Insertion is done through the urethra. Sometimes a surgical hole is made in the stomach. this connects with the bladder directly; allowing the bladder to drain into a bag.
Intermittent Catheter
Intermittent catheters are an option for both men and women. This type of catheter is more part-time than full-time. Patients use them as they need them rather than continuously. Intermittent styles can vary; they may straight or coudé tip (bending or curving slightly at the tip).
Condom Catheter
Styles are only available for men. The reason being, this option is like a sheath nothing is put into the urethra like the other types. This sheath allows the bladder to drain into a bag from a tube at the tip of the catheter. Although, patients must change them daily.
Closed System Catheter
Closed systems are another type of intermittent catheter. Systems come in a self-contained, sterile collection bag, pre-lubricated and ready to go. Due to their design, these systems are more sanitary than other options because there’s no need to touch the catheter tube directly. Limiting the risk of urinary tract and bladder contamination and infections.
Medicare offers a closed catheter system only to patients meeting the specific criteria. Common requirements like recurrent urinary tract infections during a program of intermittent cath.
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Other qualifying factors include living in a nursing facility, patients with vesicoureteral reflux, and pregnant females with spinal cord injuries with neurogenic bladders.
Inpatient Coverage for Urinary Catheters
When using a catheter during a hospital admission, at a Medicare participating facility, Medicare Part A covers the costs. You may be responsible for the Medicare Part A deductible unless you have a supplement plan.
Outpatient Coverage for Urinary Catheters
Medicare Part B covers procedures done in an outpatient setting, like a doctor’s office. Medicare Part B provides coverage for 1 indwelling catheter per month. For men, up to 35 external catheters are allowable monthly. Coverage may also include different administration and sanitation products like leg straps or anchor devices.
Beneficiaries may receive about 200 intermittent single-use catheters each month. This allows for proper sanitation when changing catheters. Although, the standard is the straight tip catheter, coverage for coudé tip catheters are available when medically necessary.
Some permanent medical conditions requiring a catheter consider it a prosthetic device. Meaning, they need it to properly use a certain part of the body due to lack of ability. In this case, Medicare will help cover the costs when it’s a medical necessity.
How to Get Help with Catheter Coverage with Medicare
Medicare Supplement (Medigap) Plans will cover all or most out-of-pocket expenses for urinary catheters after Medicare pays their portion. Medicare Part B will cover 80% of the cost, and your Medigap plan will cover the remaining 20%. Without a supplemental plan, you’ll be responsible for 20% of the cost of the urinary catheter and supplies.
Give one of our licensed insurance agents a call today at the number above. We can help you find an affordable supplement plan to help fill in the gaps in Medicare coverage. We can compare Medicare Supplement plans, Medicare Advantage plans, and Medicare Part D Prescription Drug plans. If you can’t call us, fill out an online rate comparison form to see all available policies in your area side by side.
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Does Medicare cover Supra public catheters? What is billing code
Hello Rachel,
Yes, so long as your doctor declares your suprapubic catheter as medically necessary, Medicare will cover the equipment. The billing code for the tube is A5200 whereas C2627 is the code for the device itself.
Does Medicare pay for Purewick Catheters
Hi Joan, According to the Purewick website, the Purewick System is not eligible to receive Medicare coverage at this time.
How many catheters does medicare pay a month for intermittent
Great question! Depending on the catheter, Medicare allows up to 200 catheters per month.
My mom requires to use Purewick catheter system due to her inconvenience problem plus dealing with a buttocks pressure sore stage IV. It is a shame and discriminating that Medicare no longer covers for it. It is so hard for her to afford keep buying it out of pocket. Please Medicare be reasonable and help.
Elizabeth, I am sorry to hear about your mother’s condition. You can try reaching out to the manufacturer of the Purewick Catheter System to see if they offer coupons for patients using their product.
Where do you buy the PureWick women’s external catheters for $195/month? All I’m finding is 30 for $400+/month.
Directly from liberator medical supply
Go to the purewick web site. There are 30 for $195.00 just now saw it.
Is there any type of external catheters for elderly immobile female with medicare plan b?
It is totally unfair and discriminatory that Medicare will no longer pay for external Purewick catheters for women! My mom must use them and cannot afford $195 a month. Have you been able to find out why they are no longer covering them?
Hi Donna. I’m so sorry your mother is being forced to pay out of pocket for them. I have reached out through the contact form multiple times on their website and nobody is responding.
Hi Donna, can you tell us wher you are able to find them at that price? We are paying over $400 a month for them. Thank you
Will Medicare pay for Catheters for a 86 year old man that had a stroke and now has incontinence .. We live in Mississippi and they won’t cover diapers, so I pray they will cover the Catheters.. ???
Hi Chip. Yes, as long as his doctor says the catheter is medically necessary Medicare will cover it. How much you spend out of pocket depends on what parts of Medicare he is enrolled in.
It is discrimination that Medicare will cover condom (external) catheters for men, but they will not cover external (Purewick) catheters for women!
Will Medicare cover a PureWick Female External Catheter system for a morbidly obese diabetic bed-bound woman who lives in an ALF? She has horrible skin breakdown issues as a result of both urine incontinence and pressure on her buttock/coccyx. I have an order written for this, but need to know about insurance coverage before proceeding with the order.
Hi Karen. Unfortunately, Medicare announced last month they’re no longer covering the PureWick catheter.
I don’t understand this, Medicare paid for my mother to get the system and her first 30 days of supplies, now they no longer cover them. It just cost her $195 for a month’s supply.
Hi Janine. Unfortunately, Medicare updated its coverage guidelines to no longer cover PureWick. We have been unable to find out the reason why.
My wife is 77 years old and been diagnosed with dementia does that matter
Hi John! What parts of Medicare are you trying to apply for under your wife? If she is already enrolled, what parts is she enrolled in?
Will medicare cover a system like the pure wick if it is a medical necessity? Where might I get one from an approved source?
Hi Rosie! As of recently, Medicare no longer covers PureWick.
Our issue is that the only supplier we can locate (Liberator Medical) is not approved by Medicare for reimbursement. Even DMR are denied due to not being an approved supplier. Any suggestions?
Hi Suzanne! Try using Medicares DME provider search here. Hopefully, you will be able to find an approved supplier in your zipcode.
Will Medicare cover external condom catheters for incontinence. I had prostate surgery for cancer 12 weeks ago and I have a new city parks mowing job this summer that requires me to be outside and away from restrooms for 5-6 hours at at a time. I have been using pull-.ups and pads but they don’t handle my the incontinence very well. The length of my incontinence is uncertain at this point but it does not seem to have improved since the surgery.
Hi Rod! Yes, Medicare will cover 35 external catheters per month for men. These benefits would fall under Part B. I hope this helps!
I am permanently paralyzed from chest down and transfer to bed to cath six times daily. I can not transfer to toilet to cath. Will Medicare cover enclosed system cathers?
Hi Michelle. Yes, if your doctor says it’s medically necessary then Medicare will cover it. Part B covers up 200 sterile-use intermittent catheters and individual packets of sterile lubrication per month.
Does Medicare Part B cover Pleurx catheter draining system?
Hi Monica! Yes, Medicare will reimburse you for PleurX costs for both short-term and long-term patient needs. How much you’re reimbursed depends on your specific situation. Your doctor should be able to help give you an estimate on how much you will pay upfront and how much Medicare will reimburse you.