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Thread: Medicare not covering Touchless Catheter Kits

  1. #1

    Medicare not covering Touchless Catheter Kits

    For years I have been using Bard catheter kits. My copay with Blue Cross Blue Shield was 50% but 180 Medical offered a reduction on the copay based on income. This made the kits affordable. As of this month I'm on Medicare along with supplemental insurance which I get through work. I just received a call from 180 medical informing me that Medicare will not pay for the touchless catheter kits. I was disappointed and angry to hear this. Evidently this change in coverage took place a couple of years ago. Being a quadriplegic, I do not have the ability to insert a catheter myself. My wife usually does this, but I also have part-time caregivers who use these kits. Over the years, I have had very few UTIs and I attribute that to using the touchless kits. I'm concerned that I may end up with more UTIs with several different people using straight catheters. It also would be very inconvenient to use these at my workplace.

    The representative at 180 Medical recommended taking a look at some very inexpensive catheter kits that I could pay for out of pocket. Has anyone tried these products out? Here's a couple of links he sent to me.

    https://www.medicalmega.com/medical/...yABEgJCDvD_BwE

    https://www.trypersonallydelivered.c...fo/?id=379&s=y

  2. #2
    They would rather pay for UTI treatments? That is assuming they reduce them.

  3. #3
    Medicare has pretty strict guidelines for when they will pay for touchless type catheterization kits, regardless of whether you do your own caths or they are done by someone else. Unless you can document that you meet these criteria, it is unlikely they will pay for them.

    https://www.cms.gov/Regulations-and-...ds/AB01170.pdf
    and
    https://www.cgsmedicare.com/jc/mr/pd..._catheters.pdf

    Just so you know, there is not really any good evidence that sterile catheterization outside the hospital setting has any lower rate of the development of UTI than does clean catheterization. This is the reason for the Medicare policy. They made the change to covering up to 200 catheters a month from previously requiring reuse of catheters only after pressure from the catheter manufacturers and their representatives, not from clinicians.

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  4. #4
    Senior Member jschism's Avatar
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    Sounds fishy? You mentioned that you are recently on work insurance. Are you sure it's just not your supplement insurance refusing to pay because they aren't an authorized vendor? Many times work insurance is a preferred provider type.

  5. #5
    Quote Originally Posted by SCI-Nurse View Post
    Medicare has pretty strict guidelines for when they will pay for touchless type catheterization kits, regardless of whether you do your own caths or they are done by someone else. Unless you can document that you meet these criteria, it is unlikely they will pay for them.

    https://www.cms.gov/Regulations-and-...ds/AB01170.pdf
    and
    https://www.cgsmedicare.com/jc/mr/pd..._catheters.pdf

    Just so you know, there is not really any good evidence that sterile catheterization outside the hospital setting has any lower rate of the development of UTI than does clean catheterization. This is the reason for the Medicare policy. They made the change to covering up to 200 catheters a month from previously requiring reuse of catheters only after pressure from the catheter manufacturers and their representatives, not from clinicians.

    (KLD)
    If you met the Blue Cross Criteria for the Catheters ( usually two documented UTI in a 12 month period while using a non-closed system ), Medicare should cover them too.

    In the CMS regulation links posted above:

    "Patients who currently meet the criteria for coverage of sterile intermittent catheterization asdelineated in the current DMERC regional medical review policy will be deemed to have met thecriteria as listed under this policy clarification. Once patients who require catheterization meet thecriteria as listed in this policy clarification they will continue to do so for purposes of futurecoverage."

    Can your doctor provide any medical records regarding prior UTI?

    Also-

    1. Check to be sure that the "Fifty Cent" Peco catheter price isn't just catheter kit supplies like the swabs, gloves, etc.
    Just for comparison, Allegro Medical sells both complete Peco Catheters and Peco Catheter supply kits. They charge around one dollar for the supply kit without an actual catheter and a few dollars for the whole closed catheter system including the supplies.

    2. Ask 180 Medical to send you some samples of the Peco Closed System. If you're an established customer facing a major change in your daily equipment, I'd hope they's comp you a few to try.



  6. #6
    I used touchless (totally enclosed) catheters from MTG for several years before being told that they were no longer covered. After trying some others, I settled on Cure Hydrophillic Coated straight catheters, order number HM14. Since they are pre-lubricated and include a "gripper" that eliminated any need to touch the catheter, they are at least as touchless as the enclosed catheter I used to use. I get these at no cost from JR Medical with Medicare and supplemental insurance.

  7. #7
    Senior Member smokey's Avatar
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    Medicare will cover touches or "all in one" catheter systems only if you've had 2 documented UTI's in the past 12 months.

  8. #8
    Quote Originally Posted by jschism View Post
    Sounds fishy? You mentioned that you are recently on work insurance. Are you sure it's just not your supplement insurance refusing to pay because they aren't an authorized vendor? Many times work insurance is a preferred provider type.
    Most insurance companies (to my knowledge) use Medicare guidelines for providing coverage.

  9. #9
    Smokey is correct Medicare will cover touches or "all in one" catheter systems only if you've had 2 documented UTI's in the past 12 months. You just have to have the supporting documentation. Also never send the original make copies when you send to medicare. As they have a way of misplacing the originals so you have a back up copy.

  10. #10
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    Quote Originally Posted by SCI-Nurse View Post
    Just so you know, there is not really any good evidence that sterile catheterization outside the hospital setting has any lower rate of the development of UTI than does clean catheterization. This is the reason for the Medicare policy. They made the change to covering up to 200 catheters a month from previously requiring reuse of catheters only after pressure from the catheter manufacturers and their representatives, not from clinicians.

    (KLD)
    That is what I have suspected for years, KLD. I was injured in Taiwan where they have nationalized health care. I got excellent care and 6 months of rehab. They sold a catheter made in Australia of the loveliest silicone I've experienced. Very smooth and recommended for using 6 months. It comes in a tube with a screw top so you can soak the catheter in disinfectant between uses. The Taiwanese do good research and were unable to find a significant difference between rates of infection with their cath system and the rates published elsewhere. I cannot offer links as my information came verbally through my rehab doc.

    I brought some home with me and have continued to use the little storage tubes to store my bard catheters for reuse for the last 6 years. I admit I prefer the bard because they have 2 eyes, where the Aussie caths had only one so the process was half as fast. Now I use one cath per day as I find the cheap silicone gets irritating if I use them longer. I still save a lot as I must cath often. Not suggesting this is for everyone, but it makes sense to me.

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