Understanding Medicare insurance coverage for advanced catheter requirements is crucial to qualify for medical devices like closed systems via a Medicare Advantage plan. Let’s take a closer look to help you find the information you need on advanced catheter requirements with Medicare.
Urinary Tract Infection (UTI) Risks With Using Urinary Catheters
The possibility of developing UTIs through self-catheterization is an unfortunate fact. UTIs can occasionally occur in patients who use catheterization for sterile purposes, although they are more common in those who reuse their used catheters.
Using cutting-edge catheter goods, including closed-system catheters, is one way you can reduce the risk of UTIs. Mainly self-contained closed-system catheters come with a design and features created to lower the possibility of urinary tract infections and hand contamination.
Does Medicare Cover Closed System Catheters?
If you’re considering opting for closed system catheters or other advanced urinary incontinence (UI) products, you might wonder if you qualify.
Unfortunately, closed system catheters may not be available right away for those on Medicare or an advantage plan that follows Medicare’s requirements. But if your UI condition remains persistent after sterile-use catheterization, you might be able to get your Medicare plan to fund closed-system catheters.
What Does Sterile-Use Catheterization Mean?
Sterile-use catheterization has become a common way to avoid the risk of infection in UI patients. This type of catheterization entails using a catheter only once and discarding it afterward without washing or reusing the sterile catheter lubricant packet. Put another way, you only use sterile catheters when you need to cath.
Can I Qualify To Get Closed System Catheters Through Medicare?
Qualifying to obtain closed system catheters via Medicare is possible.
You may be eligible if you have Medicare insurance or a plan that complies with Medicare requirements, practice sterile-use catheterization with new straight catheters used each time, and have had at least two UTIs in one year.
Keep in mind that it’s crucial to have evidence of your UTIs. Without proof, Medicare will not approve your insurance claim for coverage.
What Documentation Do I Need To Get Advanced Catheters?
Have you been practicing sterile use catheterization for a while and still experiencing urinary tract infections?
You may be thinking about what you should do next. Let’s make it simple to understand. You need to provide medical records and other essential documentation as verification to qualify.
Make an appointment with your doctor as soon as you notice symptoms of a urinary tract infection. Your healthcare professional needs your urine specimen to diagnose and document UTI.
Medicare also needs documentation of any other symptoms you have besides your UTI. Let’s learn about the urine culture and any accompanying symptoms.
- Urine Cultures for A UTI
As said earlier, if you suspect a UTI, make sure you see a doctor. You will be required to provide a urine specimen so the doctor can perform a proper culture test to determine if you’re experiencing UTI symptoms.
If a positive culture report shows more than 10,000 colony-forming units (CFU) in the urine culture, it indicates breeding bacteria at high counts. This type of culture is sufficient evidence of a urinary tract infection.
- Concurrent UTI Symptoms
Your doctor’s office also notes your symptoms during the urine culture test. If you experience any of the qualifying symptoms of UTI listed below, inform your doctor know right away.
- A temperature of more than 100.4°F (38°C)
- Autonomic dysreflexia, which causes sweating, blood pressure elevation, and an abnormally slow heart rate
- Increase in the number of incontinence or catheterizations you do every day
- Orchitis: inflammation in testicles that causes discomfort and swelling
- Pain in the epididymis
- Prostatitis: ongoing prostate gland inflammation
- Systemic leukocytosis: abnormally elevated circulating white blood cell (WBC ) levels.
What Might Make You Ineligible For Advanced Catheters Through Medicare Coverage?
The following behaviors can affect your eligibility for advanced catheters with Medicare:
- Avoiding the use of sterile catheters or using a new catheter each time you self-catheterize
- Cathing with a catheter lubricant tube rather than a fresh packet of sterile lubricant each time
- Repeated use of lubrication packets
Summary
Having complete knowledge about advanced catheter requirements with Medicare before visiting your doctor gives you an advantage. You can only get advanced catheters via Medicare if you had used sterile techniques when your doctor’s office recorded your UTI.
Also, using high-grade UI products from reliable manufacturers such as Active Life Medical Products is essential for safe catheterization. The leading brand can also help you file insurance claims and understand Medicare requirements.
How Active Life Medical Products Can Help With Catheter Supplies
You need a trusted catheter supplier when you require catheter supplies. Active Life Medical Products makes ordering the entire catheter supply process easy. Our Product Specialists can help you get your prescribed catheter covered through most insurances. Everything will be delivered directly to your front door.
Call Active Life Medical Products at (800) 319-2336 to place your order.
