Does Medicare Cover Urinary Catheters?
Medicare Benefits Solutions
Aug 17, 2022
Urinary catheterization is mainly used on a short-term basis to remove urine from the bladder in instances where it is blocked or after surgeries. But sometimes, using a urinary catheter at home for longer periods of time is necessary for relief if you’re having trouble with urination or mobility.
If you have been experiencing incontinence, urine retention, or are going to have surgery for prostate or other conditions that may require using a catheter, here’s some information about how Medicare recipients can get help with coverage of the supplies they’ll need at home.
Medicare Coverage for Urinary Catheters
If you undergo urinary catheterization while you are in the hospital as an inpatient, Original Medicare Part A (hospital insurance) covers the cost of inpatient surgery.
If you need catheterization when you are an outpatient, Original Medicare Part B (medical insurance) covers a portion of the cost for your supplies. This coverage is included in durable medical equipment and categorized under prosthetics and urinary supplies. The amount of coverage you get depends on the type of catheter you use.
Your Medicare Part B benefits allow coverage for one indwelling catheter per month. An indwelling catheter is one that is inserted through the urethra and into the bladder to drain urine into a collection bag. An indwelling catheter is left in the urethra for as long as it’s needed but should be changed on a regular basis to avoid infection or other complications. A nurse or physician should insert the indwelling catheter.
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Medicare Coverage for Catheter Supplies
When using an indwelling catheter, you also need urinary drainage bags that you can either attach to the bedside or to your leg. There are multi-use or single-use bags, but both types prevent the backflow of urine. Multi-use bags can be emptied and re-used, but single-use bags must be thrown away after they are used.
Urinary catheter supplies and accessories:
- Straight tip catheters
- Closed system catheters
- Irrigation trays
- Catheter stabilization device
- Catheter leg band holder
- Leg bag extension tubes
- Skin-prep wipes
- Drainage bags
Medicare recipients have coverage for up to 200 straight, single-use, sterile, intermittent catheters per month. This coverage also includes one packet of lubricant every 30 days if needed. Intermittent catheters are tubes that you, your health care provider, or caregiver insert into the urethra, allows the urine to drain from the bladder, and then immediately remove the tube. It does not stay in the urethra for extended periods of time as the indwelling catheter. You can use this method up to several times a day, depending on the need.
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Medicare benefits, Part B, also cover 35 external catheters per month for men who are experiencing incontinence. External catheters are sheaths that you put on like a condom. They cover the penis and are connected to a drainage bag to collect urine. There is not a tube inserted into the urethra like an indwelling catheter. You or your caregiver can apply an external catheter without the help of a physician or licensed nurse.
As part of your home health care benefit, Original Medicare Part B pays 80 percent of the approved cost of the supplies listed above. You are responsible for the remaining 20 percent and your Part B deductible for the current year. To get this coverage you must buy your supplies from a Medicare-accepting supplier and your health care provider must certify and provide documentation showing that using a catheter is a medically necessary treatment for your condition.
If you’re enrolled in a Medicare Advantage plan, you will have at least the same benefits as Original Medicare, but you may have additional coverage. Check with your plan directly with any coverage questions you may have regarding urinary catheters.
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Taking Care of Your Catheter
If you are in home health care and using a catheter, you or your caregiver should take special care to avoid urinary tract infection or other complications. Be sure to replace your indwelling catheter frequently, and with all types of catheters, only use sterile supplies, clean the area before insertion and after using the toilet, use lubricant when inserting tubes into the urethra, and wear gloves and clean hands afterward.
Some signals that you might have complications with your catheter include:
- Continuous bladder spasms
- Blood in your urine or around the catheter
- Fever or chills
- An excessive amount of urine that is leaking around the insertion area
- Sores on your skin around the catheter area
- Seeing stones or sediment in your urine either in the catheter tube or drainage bag
- You notice swelling around the urethra where the catheter is
- Strong smelling, thick, or cloudy urine
- Little or no urine draining into your catheter or drainage bag
- A clogged catheter, or one that is causing pain, or the area seems infected
If you have any of these symptoms, you should contact your health care provider immediately.
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