Medicare Coverage of Catheters

Intermittent catheterization (IC) is a covered benefit of Medicare and most private insurance plans. A doctor’s order or prescription is required and should reflect the actual number of times an individual catheterizes per day. The prescription must be individualized for each patient. Physicians should maintain clear documentation in the individual’s medical record of the number of times per day that the patient self-catheterizes.

In 2008, the Centers for Medicare and Medicaid Services (CMS), formerly covering the cost of only four catheters a month for those individuals managing their bladder with IC, opened its coverage policy for up to 200 single-use, disposable catheters per month. Now any Medicare beneficiary who meets the basic coverage criteria of permanent urinary incontinence or urinary retention can receive one sterile urological catheter and one packet of lubricant for each episode of covered catheterization.

IC using a sterile intermittent catheter is covered when the user meets one of the following criteria:
1) Residents of a nursing facility
2) Immuno-suppressed patients such as those with AIDS or on cancer chemotherapy
3) Documented vesico-ureteral reflux
4) Pregnant, spinal cord injured patients
5) Patients with two or more documented UTI/year

Because of the relative newness of this ruling, your provider may not be aware of the change. Ask about this policy change if you could benefit. Always keep in mind that regular visits to your healthcare provider are required to maintain the integrity and usefulness of the catheter regimen.

Adequate fluid intake is necessary for good bladder health. A daily intake of 30ml/kg (5oz/ 10lbs) of body weight is currently recommended. For a person who weighs 160 pounds and who is moderately active, this translates to about 2 ½ quarts of liquid daily. This avoids concentrated urine that can cause other bladder problems. Contact your healthcare provider to make sure this amount of fluid is not contraindicated with any other chronic medical problem.