For Medicare Beneficiaries, please read our article entitled "Annual Wellness: Things to Know".
Important information on 2011 Medicare Open Enrollment.
What Does Medicare Cover?
Medicare covers most urological products for patients who qualify based on their diagnosis, the documentation of the permanent nature of their condition, and the frequency of use. Coverage includes Intermittent Catheters, Condom Catheters, Leg Bags, Bedside Bags, Foleys, and Lubricant.
Medicare covers up to 200 single use intermittent catheters per month with individual lubricant packets.
S2 Medical Supply strictly follows the Medicare guidelines for intermittent catheter use. Medicare requires that a beneficiary have permanent urinary incontinence or retention. Catheter usage should reflect the individualized plan of care as prescribed by your physician. Your physician must document on the prescription the frequency of use and the number of catheters per month. Medicare requires your physician to maintain all information about your catheter program in your medical record.
S2 Customer Care Specialists work with you and your physician to ensure all your paperwork and documentation is accurate and current so you receive your supplies worry FREE.
Medicare also covers Closed-System Intermittent Catheters and Intermittent Catheters with Insertion Kits if the beneficiary has permanent urinary incontinence and the beneficiary has at least one of the following criteria documented in their medical record:
•The beneficiary has at least two (2) distinct, recurrent urinary tract infections (UTI’s) within 12 months of each other, while they are on a plan of sterile intermittent catheterization (see UTI documentation requirements below), or
•The beneficiary lives in a nursing home, or
•The beneficiary is immunosuppressed, or
•The beneficiary has radiologically determined vesico-ureteral reflux while on a plan of intermittent catheterization, or
•The beneficiary is a pregnant female who has a spinal cord injury with neurogenic bladder
Urinary Tract Infection (UTI) Documentation Requirements
Medicare requires a urine culture with greater than 10,000 colony forming units of a urinary pathogen and one or more of the following:
• Fever (measured orally) greater than 100.4 F
• Pyuria; white blood cell count greater 5 per high power field (HPF)
• Change in urinary urgency, frequency, or incontinence
• Appearance of dysreflexia or increase in existing dysreflexia (sweating, slow heart rate, elevated blood pressure)
• Physical signs of prostatitis, epididymitis, orchitis
• Systemic leukocytosis
• Increased muscle spasms
S2 Customer Care Specialists can assist you with the process involved in order to receive the correct supplies if you are experiencing one of these criteria. Call an S2 Customer Care Specialist to receive the information and help you need.
Medicare covers most ostomy supplies such as ostomy pouches, skin barrier, face plates, powders, adhesive, belts, stoma caps, appliance cleaner, lubricant, and irrigation supplies. Our friendly Customer Care Professionals can answer all your questions about the supplies you use.