Catheter Documentation Reference Guide
Please consider using this documentation when ordering catheters for the first time and at their consecutive visits. This will carry over from visit to visit in the note and will help avoid the need for addendums.
Medicare and Insurance Documentation
Requirements for Intermittent Catheters
- The patient must have chronic or permanent urinary retention.
- The prescribing physician must clearly document in the patient’s medical record the number of times per day that you are instructing them to perform self- catheterization. Just listing that value on an order form is not sufficient.
Ex: “The patient should perform CISC 4 times per day.”
Coude’ Tip Catheters
- If your male patient is needing a coude’ tip catheter, please add the following or similar verbiage to your office visit notes for medical necessity.
Ex: “The patient needs to use a coude’ tip catheter because he is unable to pass a straight tip catheter due to ___________ (BPH, Urethral Stricture, false passage, etc..)
What Catheter Supplies Are Eligible Through Medicare?
For Intermittent Catheters:
Medicare allows up to 200 intermittent catheters and lubricant packets per month.
For Foley (Indwelling) Catheters:
Medicare allows one (1) Foley catheter, one (1) insertion kit, two (2) leg drainage bags, and two (2) bedside drainage bags per month
For External Condom Catheters:
Medicare allows up to 35 External Catheters per month, two (2) leg drainage bags, and two (2) bedside drainage bags per month.
Do Other Insurance Carriers Pay For Urological Supplies?
We are contracted with NYS Medicaid many Private, Commercial, and Managed Care insurance carriers. Each plan has a separate benefit and from our experience almost every carrier has some benefit for catheter supplies.
What If A Patient Is In A Skilled Nursing Facility Or Has A Home Health Episode?
*Important* – Medicare will not cover any Urological Supplies while a patient is in a Skilled Nursing Facility such as a hospital or rehabilitation facility. They also will not cover supplies during any Home Health Episode where there is an agency providing nursing care, a home health aide or rehab in your home. During that period, the facility or the agency is responsible for providing these supplies.
Once that home health episode is over, we can begin or resume supplying the patient with Catheter Supplies.