External Catheters/urinary Collection Devices
Male external catheters or female external urinary collection devices are considered medically necessary for members who have permanent urinary incontinence when used as an alternative to an indwelling catheter.
Generally, no more than 35 male external catheters are considered medically necessary per month.
Note: Adhesive strips or tape used with male external catheters with adhesive strips or adhesive coating are included in the allowance for that code and are not separately payable.
Male external catheters or female external urinary collection devices are not considered medically necessary when ordered for members who also use an indwelling catheter.
Specialty-type male external catheters such as those that inflate or that include a faceplate are considered medically necessary where the clinical situation justifies their need.
A meatal cup female external urinary collection device is a plastic cup, which is held in place around the female urethra by suction or pressure and is connected to a urinary drainage container such as a bag or bottle. A pouch type female external collection device is a plastic pouch which is attached to the peri-urethral area with adhesive and which can be connected to a urinary drainage container such as a bag or bottle. For female external urinary collection devices, more than 1 meatal cup per week or more than 1 pouch per day are not considered medically necessary.
Alternatives To Incontinence Bed Pads
An incontinence pad isnt the only option for protecting your bed and keeping you dry. Other options include:
- Wearable pads. There are pads that fit in your underwear and are designed specifically for incontinence, like these options by Depend for Men.
- Incontinence underwear. The brief itself is made from absorbent fabric, like these options from Thinx.
- Waterproof mattress covers. There are water-repellant mattress covers designed like a fitted sheet. Or there are covers that fully enclose the mattress to repel moisture, like this non-vinyl option from SafeRest.
- Disposable fitted sheets. These PEELAWAYS fitted sheets are disposable and cover the entire bed. You can peel away the top fitted sheet layer to reveal another bed pad. The main catch with these is theyre only made for twin XL sizes, so you must have a bed that specifically fits this option.
Finding A Specific Code
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Will Insurance Cover Incontinence Treatments
Although most people are too embarrassed to speak with a clinician and will try to manage bladder leaks on their own, urinary incontinence only worsens with age. The underlying problem in stress urinary incontinence is a weakened pelvic floor. The first line of treatment with urinary incontinence is Kegel exercises, which aim to strengthen pelvic floor muscles to help control urine flow. But these exercises are difficult to perform sustainably.
Other treatments for urinary incontinence include laser therapy, pelvic floor physical therapy, and Botox, as well as magnetic stimulation and implants. These treatments can require multiple office visits and continual fees. Lasers, magnetic chairs, and other treatments that are more investigational are NOT covered by insurance. However, Botox injections may be partially covered by Medicare for urge incontinence. For severe cases, insurance may cover the cost of surgery after other conservative treatments have been exhausted.
ELITONE is available for purchase without a prescription, however, private insurance groups may cover it with a prescription from your treating physician. Ask your insurance provider whether they cover non-implanted pelvic floor electrical stimulators HCPCS/DME code E0740. Medicare coverage includes renting the device for a time with some out-of-pocket expense, again with a physicians prescription.
How Do I Know If Im Covered
Aeroflow Urology, a provider of continence care supplies through insurance, can help you determine your coverage for incontinence products. They take the hassle out of working with your insurance company and will handle all of the communication and paperwork on your behalf. Theyll even work with your healthcare provider to confirm your specific needs and get the appropriate documentation to ensure your supplies are fully covered.
The process to work with Aeroflow Urology is simple. Fill out their quick, two-step form and theyll take care of the rest . If you prefer to talk with someone over the phone, you can call Aeroflow Urology at 844-276-5588 and speak with a specially trained Continence Care Specialist.
Once your information is received, you will be assigned a dedicated Continence Care Specialist who will begin working to verify your coverage. They will contact you via phone or email to review your benefits and will then work with you to determine the brand and product type that will work best for you.
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What Customers Say About Activstyle
Its just the greatest thing to have ActivStyle for my active life. I tried several different kinds of pullups before ActivStyle, but when I got the pullups from ActivStyle, they just fit. Thats a wonderful thing to have them fit like regular underpants. ActivStyle has really helped me because Im an active person. Now I can get out and go and not worry about having embarrassing accidents in public.Diann
Ive been using ActivStyle about three years now. ActivStyle has given me freedom. I can go out and do things without any worries, about any leaks happening. And the pullups, I love the comfort, a slim design, I can wear anything with them without feeling uncomfortable or anything. When I go out, I feel really protected.Connie
Monday Friday 8:00 AM to 7:00 PM CST
ActivStyle is the easy, convenient way to get incontinence supplies!
We will do all the work to confirm your eligibility, ship discreetly to your door, and get you back to living life with confidence and comfort.
Dont spend another day waiting Contact us today to get started.
Yes! I am new to ActivStyle, please call me to see if I qualify for incontinence supplies through insurance.
If you are new to ActivStyle, please complete the form below and we will call you back to determine your eligibility to receive supplies through your insurance plan.
Why Doesn’t Medicare Cover Incontinence Supplies
Medicare recipients with incontinence will only be covered for treatments that are deemed medically necessary. Because adult diapers, pads and other supplies are not classified as medically necessary, Medicare does not pay for Depends or other incontinence supplies.
However, Original Medicare may cover medically necessary appointments and procedures related to diagnosing and caring for incontinence.
Medicare Part A covers inpatient hospital services
Medicare Part B covers doctors services and durable medical equipment , which can include catheters in some cases
Also Check: How Much Is Part B Deductible For Medicare
Us Department Of Veterans Affairs
The Department of Veterans Affairs does provide adult diapers as part of its VA health benefits. But it typically provides a standard issue type of adult diaper.
If you want a brand-name product such as Depend or Attends your doctor will have to provide the VA with a prescription or a statement of medical justification explaining the medical necessity as to why you need a particular brand.
Veteran-Directed Care also called Home and Community Based Services is a VA program that provides financial assistance to veterans. Its designed to give vets the flexibility to determine how to best spend the aid on their particular needs. If you qualify, you can use the assistance toward incontinence supplies.
Tips On Changing Used Pads And Sheets When The Bed Is Occupied
If youre changing pads for a loved one whos bed-bound or has difficulty with transfers, you can also use some nursing tricks to replace the pad or linens without having your loved one get out of bed.
For example, if youre changing a pad or sheets:
This method is helpful for those who cant get out of bed easily because they can have clean sheets without having to get up often.
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How Do You Qualify For Incontinence Products From Medicare
If the patient is confined to a single room in their house, Medicare will cover a commode chair if a doctor orders it.
Medicare will reimburse you for 200 single-use catheters per month with a doctors prescription and a diagnosis of permanent urinary incontinence or urinary retention. The patient or a caregiver must be able to insert the catheter rather than having a skilled nursing attendant do so.
Medicare might cover closed system intermittent catheters and sterile intermittent catheters with insertion kits under certain conditions. If the patient has permanent urinary incontinence documentation and either has two UTIs while using sterile intermittent catheterization in 12 months or lives in a nursing home. This treatment might be approved if the patient has had radiologically vesicor-ureteral reflux while using intermittent catheterization, is immunosuppressed, or is a pregnant female who has a spinal cord injury and has a neurogenic bladder.
As you can see, the prerequisites are pretty specific, so you shouldnt count on Medicare as your source of free incontinence supplies.
Will Medigap Or Medicare Advantage Plans Cover Disposable Incontinence Supplies
Medigap Medicare Supplement insurance plans will not cover disposable incontinence supplies. But some Medicare Advantage plans will.
Medicare Advantage plans are sold by private insurers. These plans are required by law to cover everything Original Medicare does, but they are allowed to provide additional benefits. Some plans will cover incontinence supplies.
Medicare Advantage plans differ depending on where you live and what plan you have. You should check with your plans administrator to see if your Medicare Advantage plan covers the specific supplies you need or already use.
Continuous Irrigation Of Indwelling Catheter
Supplies for continuous irrigation of a catheter are considered medically necessary if there is a history of obstruction of the catheter and the patency of the catheter can not be maintained by intermittent irrigation and catheter changes. Continuous irrigation has not been proven to be of benefit as a primary preventative measure .
Medically necessary supplies for medically necessary continuous bladder irrigation include a 3-way Foley catheter, irrigation tubing set, and sterile saline or sterile water. More than one irrigation tubing set per day for continuous catheter irrigation is not considered medically necessary.
Irrigation solutions containing antibiotics and chemotherapeutic agents are considered experimental and investigational because their value is unproven. Irrigating solutions such as acetic acid or hydrogen peroxide, which are used for the treatment or prevention of urinary obstruction, are of no proven value. Sterile water or sterile saline are considered medically necessary for use as irrigation solutions.
Continuous irrigation is a temporary measure continuous irrigation for more than 2 weeks is rarely considered medically necessary.
What Are Incontinence Supplies
Incontinence supplies are designed to protect furniture, bedding, and clothing from urine or feces. Incontinence supplies worn by an individual include adult diapers, incontinence liners, and protective underwear. Other items include bedpans, catheters, and underpads like bed pads or chux pads. Disposable gloves, wipes, commode chairs, and barrier creams are also lumped under the category of incontinence supplies. The level of incontinence protection you need may vary, meaning you may need more than one type of product.
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Benefits Of Insurance Medicare Vs Medicare Advantage Plan For Incontinence
You may be surprised to learn that Medicare insurance does not cover incontinence supplies or adult diapers. These can cost an average of $300.00 monthly. Medicare Advantage plans are provided by private insurance companies and sometimes include a wider range of benefits. Heres what you need to know about the benefits of insurance Medicare Vs
What Medicare Plans Cover Incontinence Supplies
There are some supplies that are an exception to the above. Supplies such as catheters might be covered if you provide the proper documentation. These rules apply only to traditional Medicare, so if you have a Medicare Advantage plan, you may be able to receive coverage. Some Advantage plans do provide coverage for incontinence supplies, and if yours does, you will be able to work with your doctor to gain approval.
Medicare Supplement plans won’t cover this expense. If you’re enrolled with a traditional Medicare plan or a Medicare Advantage plan that doesn’t provide coverage, you need to consider other ways to reduce the cost of your incontinence supplies.
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Optional Medicaid Benefits States May Offer:
Speech, hearing and language disorder services
Prescription drug coverage
View the full list of mandatory and optional Medicaid benefits here.To understand all the specific services and benefits that are covered in your state, we recommend contacting your state-provided plan, your insurance provider or conducting research on your states Medicaid website.
Dual Eligibility And Medicare Special Needs Plans
In some states, Medicaid may cover incontinence supplies.
If you qualify for both Medicaid and Medicare, you may be eligible for a Medicare Special Needs Plan that helps cover incontinence supplies.
Medicare SNPs are a type of Medicare Advantage plan that limits membership to people with specific conditions or circumstances .
Medicare SNPs cover the same Medicare services that all Medicare Advantage plans must cover, and many plans also cover extra services tailored to the groups they serve.
Finding a Medicare Advantage plan that covers incontinence supplies may take some shopping around. SNP plans usually arent as widely available as regular Medicare Advantage plans. Whats available in your area can vary significantly from other areas. But dont worry, you dont have to do it alone!
Our licensed insurance agents can help you compare Medicare Advantage plans in your area to see whats available and what you may be eligible for.
Find Medicare Advantage plans in your area
Or call 1-800-557-6059TTY Users: 711 24/7 to speak with a licensed insurance agent.
1 Kaiser Family Foundation. An Overview of Medicare. . Retrieved from www.kff.org/medicare/issue-brief/an-overview-of-medicare.
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Does Medicare Cover Adult Diapers
Original Medicare, Part A and B, doesnât consider adult diapers or other incontinence supplies, such as adult briefs, pads, or liners, to be Durable Medical Equipment or supplies, and therefore doesnât cover these items.
Original Medicare only covers durable medical equipment when it meets the defined criteria established by Medicare. To meet Medicareâs criteria for DME, an item must be durable or long-lasting used for a medical reason not usually useful to someone who isnât sick or injured and used in your home.
If you are eligible for Medicaid, you may be able to get financial assistance to cover the cost of adult diapers. To apply for Medicaid or for more information, contact your state Medicaid office.
Since Original Medicare doesnât always cover the supplies, services, and treatments you may need, you might want to consider a Medicare Advantage plan. Your health concerns will determine which plan may work for you. For help figuring this out, feel free to contact eHealth!
Can You Get Free Incontinence Pads
While Medicare doesn’t cover incontinence supplies except for very specific circumstances, there are ways to get these products for free or to save a lot of money on your purchases. You can do the following if you are unable to receive coverage through your Medicare Advantage plan as well.
While Medicare doesn’t cover incontinence supplies in most cases, you may be able to receive coverage through a Medicare Advantage plan or reduce your costs significantly through other assistance programs. Your doctor can help you determine if you are eligible to receive any of these benefits and provide the documentation you need for approval. It is certainly possible for you to reduce the cost of your supplies to be able to afford them.
American Hospital Association Disclaimer
The American Hospital Association has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.
What Types Of Incontinence Products Could I Receive Through Insurance
Your coverage for supplies will depend on your specific insurance plan benefits. If you are new to life with incontinence and are unsure which products will best suit your needs and lifestyle, Continence Care Specialists such as those working for Aeroflow Urology, can talk you through various product types and can assist you in trying samples of different products and brands.
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