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Medicare will
cover sterile single-use intermittent catheters in quantities up to 200 per month
with individual packets of lubricant. |
- The basic coverage criteria
of permanent urinary incontinence or retention must be met.
Medicare members may receive quantities of catheters as ordered by their physicians
to meet their specific
needs. - Your prescription must
clearly state the frequency of catheterization, as well as the quantity of catheters
required on a monthly basis.
- Clinical documentation
is required to support quantity or frequency of use that is greater than 200 per
month or 6 per times per day.
- The number of times
per day that an individual performs self-catheterization should be clearly documented
in your medical record.
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Medicare will
cover closed system intermittent catheters or sterile intermittent catheters with
insertion kits when the member has permanent urinary incontinence, and there is
documentation that individuals meet one of the following criteria: |
- The Medicare member
has 2 distinct, recurrent UTI’s while on a program of sterile intermittent catheterization
(sterile intermittent catheters with sterile lubricant) within 12 months of each
other; or -
- The Medicare member
resides in a nursing facility; or
- The patient is immunosuppressed;
or -
- The patient has a radiologically
documented vesico-ureteral reflux while on a program of intermittent catheterization;
or -
- The patient is a spinal-cord
injured pregnant female with a neurogenic bladder
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How does Medicare
define UTI documentation? |
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Urine culture
with > 10,000 cfu (colony forming units) of a urinary pathogen AND concurrent
documented presence in the urine culture of only one (1) of the following: |
- Fever (oral temperature
> 100.4 Degrees F)
- Pyuria; elevated white
blood cell count (wbc) > 5
- Change in urinary urgency,
frequency or incontinence
- Appearance of new or
increase in autonomic dysreflexia (sweating, low heart rate, elevated blood pressure)
- Physical signs of prostatitis,
epididymitis, orchitis
- Increased muscle spasms
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