“Your Right to Choose”
Are you having difficulty receiving your Coloplast catheter?
At Coloplast, our mission is to make life easier for those with intimate healthcare needs. We understand finding a product that fits your needs and lifestyle may take time. And, once you’ve found a product that works for you, it can be frustrating when your catheter of choice is no longer available.
It’s your right to choose.
It is important that you have access to the intermittent catheter you and your clinician determined best meets your needs. If your medical supplier tells you that Coloplast catheters are not available for any reason, we may be able to help you find an in-network supplier that will honor your and your clinician’s choice.
We are committed to helping you find a supplier that will accept your insurance and dispense your preferred product.
Understanding coverage criteria
The criteria for insurance providers to cover intermittent catheters is fairly standard.
- The medical record usually indicates the term “permanent urinary incontinence” or “permanent urinary retention.”
- All intermittent catheters fall under a billing code (HCPCS Code).
- Some insurance plans may require additional documentation to provide medical necessity
How many catheters are allowed per month/day?
The number of intermittent catheters covered by insurance per month is dictated by the insurance plan.
- Up to 200 catheters per month for each type (straight tip, coude (bent) tip, closed system, hydrophilic or non-hydrophilic coating)
For Medicare, the allowance is:
- The frequency of use (for example, 5 times per day) depends on your medical condition.
- Your healthcare provider needs to clearly document the frequency of catheterization in your medical record and include the quantity on your prescription.
- TIP: The quantity needs to be an exact number and not a range!
Accessories – what does Medicare cover?
- Lubricant (HCPCS code A4332 )
- For each episode of catheterization an individual packet of lubricant is covered
- Hydrophilic intermittent catheters do not require lubricant.
- Extension tube (HCPCS code A4331)
- 24” extension tube which attaches to handle-end of the intermittent catheter allowing the individual to reach the toilet from a wheelchair position or other position preventing easy access to toilet
Other information
How can I order and receive my catheters?
- Local DME suppliers (may or may not work with your insurance plan, check your benefits)
- Those with storefronts allow the individual to pick up product and not have to wait for delivery
- Those that do not have storefronts will ship the catheters directly to your residence
- Regional/National DME suppliers (may or may not work with your insurance plan, check your benefits)
- Will ship the catheters directly to your residence
Ongoing prescription
Most prescriptions are valid for 12 months, however some guidelines vary based on the state you reside in (and/or the insurance you have). =. If your medical needs or condition changes, or you require a different type of catheter or the frequency of catheterization changes you may require a new prescription.
If you experience challenges in obtaining Coloplast intermittent catheters covered, please contact us directly at 1-866-226-6362.
We will help you address the issue.
Links to Medicare resources
- Center for Medicare and Medicaid Services - http://www.cms.gov/
- Medicare Pricing, Data Analysis and Coding - https://www.dmepdac.com/
Disclaimer: The information in this document is informational only, general in nature, and does not cover all payors’ rules or policies. This document represents no promise or guarantee by Coloplast Corp. regarding coverage or payment for products or procedures. Reimbursement, coverage, and payment policies can vary from one insurer and region to another and is subject to change without notice.
Coloplast Corp. provides this information for your convenience only and makes no warranties or guarantees, expressed or implied, concerning the accuracy or appropriateness for any particular use of the information provided. It is always the provider’s responsibility to determine coverage and submit appropriate codes, modifiers, and charges for the services that were rendered. It is neither legal advice nor advice about how to code, complete or submit any particular claim for payment or to increase or maximize reimbursement by any third party payor. Existence of or assignment to a particular code with or without an associated payment amount does not guarantee coverage or payment.
