Medicare Documentation for Catheters
Medicare will cover up to 200 intermittent catheters per month when prescribed and medically necessary. If your patient requires intermittent catheterization, Medicare requires proper documentation and a prescription, which should specify the diagnosis (reason for needing catheters) and how many times per day the patient should catheterize.
Please note that the frequency must be clearly documented in the patient's medical record. Merely listing the value on an order form is not considered sufficient. For example, "The patient should perform CIC 4 times per day."
The documentation should also include the need for catheters due to an approved ICD-10 diagnosis (including urinary retention, incomplete bladder emptying, urinary incontinence, or urge incontinence).
In addition, be sure to note if the need for catheters is a chronic, long-term, or permanent condition. If the length of need is at least 3 months, this will meet the requirement.
Coudé Catheter Justification
If your patient cannot pass a standard straight tip catheter, Medicare may also cover coudé tip catheters. However, this should be documented well in the progress notes in addition to the above notation.
The notes should demonstrate medical necessity and why a straight catheter is insufficient for the patient's needs. For example, "The patient needs to use a coudé tip catheter because he is unable to pass a straight tip catheter due to (BPH, urethral stricture, false passage, etc.)."
Will Other Insurance Carriers Pay for Catheters?
Yes, in addition to Medicare and Medicaid plans, many private insurance plans cover catheter supplies when medically necessary and prescribed.
At All American Medical Supply, we're contracted with a wide range of plans, including NYS Medicaid, NYSHIP, Anthem BlueCross BlueShield, and more. Each plan typically has different benefits and coverage options, but most every carrier offers some coverage for catheter supplies.
What If a Patient Needs Home Health Services?
What If A Patient Is In A Skilled Nursing Facility Or Has A Home Health Episode?
Unfortunately, Medicare will not cover any urological supplies from a separate supplier while a patient is receiving Home Health services or is in a Skilled Nursing Facility, including hospitals or rehabilitation facilities.
During this period, the facility or Home Health agency is responsible for providing urological supplies.
However, once the Home Health episode is over, we can resume supplying the patient with their catheter supplies.
