Urological Supplies - Policy Article

Urological supplies (catheters and external urinary collection devices) are covered under the Prosthetic Device benefit only when the beneficiary has documented permanent urinary incontinence or permanent urinary retention and the item meets Medicare benefit, statutory, and related LCD reasonable-and-necessary requirements. Certain HCPCS-coded items require a face-to-face encounter and a Written Order Prior to Delivery (Final Rule 1713) and strict modifier and billing rules (AU, KX/GA/GY/GZ) apply; many incontinence-related products and uses not directly related to drainage/collection are non-covered.

"Urinary catheters and external urinary collection devices are covered when the beneficiary has documented permanent urinary incontinence or permanent urinary retention."

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