Medicare Coverage of Catheters

A little noticed policy change was announced in May 2008 by the Centers for Medicare and Medicaid Services (CMS) of the Department of Health and Human Services in Washington, DC that could positively impact the safety and quality of care for millions with chronic diseases and conditions.

Medicare, formerly covering the cost of only four catheters a month for those individuals managing their bladders with intermittent, self-catheterization throughout the day, has opened its coverage policy for up to 200 single use, disposable catheters per month in a number of defined circumstances. These include self-catheterizing, Medicare beneficiaries who meet one or more of the following criteria:

• Residents of a nursing facility
• Immunosuppressed patients, such as those with AIDS or on cancer chemotherapy
• Patients with documented vesico-ureteral reflux
• Pregnant, spinal cord injured patients
• Patients with recurrent urinary tract infections

While self-catheterization with reuse of catheters over the course of a week's period of time and following "clean technique" for cleansing and storing supplies has worked successfully for millions of people over the years, for others the practice has been untenable and downright unsafe because of the possible complications and risks associated with costly infection. From the outset, no catheter has been approved by the FDA for anything but single use in the U.S. However, the economics faced by private citizens of their circumstances have forced reuse of the device.

For once, CMS has finally acknowledged that a "one size fits all" approach to coverage and reimbursement policy doesn't belong in our healthcare system and certainly not for those with chronic illnesses and conditions such as multiple sclerosis, spinal cord injury, and spina bifida. We've simply got to do better than taking a pantyhose approach to healthcare for our nation. Thank you, CMS! And thank you, long time advocates who have fought to get CMS' attention, with the help of Congress.

If you need more information because of a chronic, neurological disease or condition, visit http://www.nafc.org/bladder-bowel-health/neurological-disorders-2/