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Guidelines for Catheters Under Medicare

The use of a catheter is fairly common when health issues occur, specifically after surgery or in the hospital. The bill can climb quickly in situations like that, but Medicare may be able to help by covering the costs of catheter use.

What is a catheter?

A catheter is a flexible tube that is inserted into a narrow space in the body in order to remove excess fluid The most common place on the body is the bladder. There are two main types of catheters that are used for specific situations.

The indwelling catheter stays inside the body for a long period of time. In addition, there are two different types of indwelling catheters that are commonly used. First is the urethral indwelling catheter and it is inserted through the urethra into the bladder. Second is the suprapubic indwelling catheter and it is inserted through the stomach directly into the bladder.

An intermittent catheter is inserted into the urethra in order to empty the bladder then removed as soon as the bladder is completely empty.

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Medicare coverage

Medicare will offer coverage for intermittent catheters that are used only once. Medicare will cover up to 200 straight catheters and a packet of lubricant each month. In order for this to be covered, proper documentation is required from your doctor.

The documentation is typically referred to as PDF. PDF stands for the permanence of the condition, the diagnosis, and the frequency.

Advanced products

Medicare will cover catheters that are considered advanced products, such as closed system catheters or hydrophilic catheters with insertion supply kits. However, these types of catheters require more paperwork in order for Medicare to cover them.

Your doctor must document that you have had at least two urinary tract infections (UTIs) during the time you were using sterile intermittent catheters and sterile lubrication packets within a twelve-month period.

Talk to your doctor about your options and what Medicare may offer you under their care.

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