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Thread: Number of drainage bags allowed by Medicare

  1. #1

    Number of drainage bags allowed by Medicare

    Although husband has been using colostomy supplies for years, we are new to ordering urology supplies. Does anyone know how many bags a month are paid for by Medicare? We have the weirdest supplier and they are making this so confusing. We have to use them because of our insurance. I was told today they only send one months supply at a time and only 2 night bags and 2 leg bags are allowed by Medicare. Is this correct?

  2. #2
    Just out of curiosity......who is your supplier? Your supplier sounds like mine. I get my supplies from Edgepark, and they are masters of flim/flam language and interpretation of what I am eligible to receive. With Edgepark, every month is an adventure...every order in question, until I know that it has been shipped. That said.....
    Generally speaking what you are getting is standard from Medicare for urinary collection devices. I get four disposable leg bags a month (approved by Medicare) because of my history of frequent urinary tract infections (UTIs). My doctor has made the case to Medicare and has lab tests to back him up and Medicare allows 4 disposable legs bags a month for people who suffer frequent UTis. I use a rigid collection bottle (for night collection) made by Urocare, and I am eligible to receive one of those every 3 months.
    Hope this helps.
    All the best,

  3. #3
    The supplier is NationsHealth and they are horrible. We just had to switch to them and have nothing but problems. The most amazing thing is that they have no catalog. The order clerk said I have to have the reference numbers and when I asked where I should get them she said she didn't know. Sweet.... Then she said I have to give the numbers to the doctor and he has to fax them to the supplier and if they don't carry that particular item they will give me a call. Meanwhile we are paying out of pocket for the supplies for which I'm paying a boatload in insurance premiums.

  4. #4
    By "reference numbers," do you mean the (1) order number from your supplier, (2) product number/code given to the product by the manufacturer, or (3) medical/insurance/medicare code?

    I think all manufacturers of urological supplies apply product numbers to their line of supplies. If you know the manufacturer, product type etc. you are looking for, go to the manufacturer's website and search their products to find these numbers. Or if you have products that you are currently using, you will find re-order or product codes on the original packaging. You could supply these numbers with product description to your doctor so that he can fax the references to exactly the products you want.

    The medical supplier's (NationsHealth) codes for the products you want may vary from the manufacturers product/order numbers. They will have to supply those numbers. Try talking to NationsHealth's billing department rather than an order clerk.

    Medicare uses HCPCS codes to reimburse for products. For instance:
    A4357 - Bedside Drain Bag
    A4358 - Urinary Drain Bag Attached to Leg
    A5102 - Bedside Rigid Drain Bottle
    Frequency of use/replacement:
    2 - Bedside Drain Bags per month
    2 - Drain Bags Attached to Leg per month
    1 - Bedside Rigid Drain Bottle per 3 months

    If you have frequent urinary tract infections, your doctor needs to document that to medicare and the supplier with a letter of medical necessity and probably use some diagnosis codes, i.e., CPT code or ICD-9 codes (which ever is applicable) and lab test data for proof. Frequent UTIs qualify for 4 legs bags per month.

    Good luck figuring out what codes you need to supply and to whom.

    All the best,

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