Does Medicare Cover Incontinence Treatments?
Different parts of Medicare will cover certain incontinence treatments. Original Medicare — Part A and Part B — and Medicare Advantage plans will cover catheters, surgery and medical devices deemed a medical necessity. Medicare Advantage and Part D plans will cover certain incontinence medications
Does Medicare Cover Catheters for Incontinence?
Original Medicare — Medicare Part A and Part B — and Medicare Advantage plans will cover certain types of catheters for the treatment of incontinence if they are deemed medically necessary. Depending on the type of catheter your doctor orders, Medicare will pay for at least one to as many as 200 catheters per month.
- Intermittent catheters
- Medicare will pay for up to 200 intermittent catheters per month. As these are single-use catheters, the coverage allows you to use up to six per day, with additional catheters leftover each month.
- Foley (indwelling) catheters
- Medicare covers one Foley catheter, or indwelling catheter, per month. If you have a documented health condition that requires more frequent changes, Medicare will increase your coverage to two to four per month.
These types of catheters are generally made of latex or silicone. You will need your doctor to document a latex allergy to qualify for a silicone version.
- External catheters
- Medicare will cover up to 35 external catheters per month. These types are also called MECs (male external catheters) or Texas catheters.
Medicare Coverage for Closed Catheter Systems
You have to meet one of several criteria to be eligible for Medicare coverage of closed catheter systems. These types of catheters are considered to be more sanitary than intermittent catheters.
- You suffer recurring urinary tract infections while using sterile intermittent catheters
- You require intermittent catheterization and have vesicoureteral reflux — a condition in which your urine flows in the wrong direction
- You are in a nursing facility
- You are immunocompromised
- You are pregnant and have a spinal cord injury that causes neurogenic bladder — a form of bladder dysfunction caused by neurologic damage
Closed catheters are self-contained systems consisting of a pre-lubricated catheter and a collection bag. The bag eliminates the need to void your urine into a toilet or other receptacle.
Medicare Coverage for Catheter-Related Supplies
Medicare will also cover certain catheter-related supplies including irrigation kits and syringes, bedside drain bags, leg bags and extension tubing.
Make sure your supplier is enrolled in Medicare and accepts assignment — meaning that the supplier will accept the Medicare-approved price for supplies.
Also, check that the company you’re using has a Medicare supplier number. Without this number, Medicare will not pay your claims and you may be stuck paying whatever price the supplier decides to charge you.
Does Medicare Cover Incontinence Surgery?
- Medicare covers urethroplasty — a surgical procedure that repairs an injury or defect within the walls of your urethra. But you are responsible for your Part B deductible and 20 percent of the remaining Medicare-approved cost of the surgery.
Medicare estimates your average out-of-pocket costs at $610 in an ambulatory surgical center and $1,080 in a hospital outpatient department.
- Transurethral radiofrequency micro-remodeling
- Medicare will help pay for this procedure to treat urinary stress incontinence in women. It uses energy from radio frequencies to shrink and stabilize tissue in your body to support your urethra and bladder neck.
You are responsible for your Medicare Part B deductible and a 20 percent coinsurance payment based on the Medicare-approved cost for the procedure. Medicare estimates your average out-of-pocket costs at $204 in an ambulatory surgical center and $403 in a hospital outpatient department.
Medicare may help pay for other incontinence surgical procedures. Talk with your doctor about Medicare coverage for any surgeries recommended for you.
You can also call Medicare at 1-800-633-4227 to ask if a procedure is covered. If you have a Medicare Advantage plan, contact your plan’s administrator.
Does Medicare Cover Incontinence Drugs?
Original Medicare does not cover prescription drugs that control incontinence. But you can purchase a Medicare Part D prescription drug plan that can help pay for prescription medications if you have Original Medicare.
You can also purchase a Medicare Advantage plan with prescription drug coverage included. Medicare Advantage plans are required to cover everything that Original Medicare covers, but they may offer additional benefits that Medicare Part A and Part B do not.
Both Medicare Part D drug plans and Medicare Advantage plans are sold by private insurers.
Drug treatments for incontinence include hormones, certain antidepressants and a class of medications called anticholinergics. Depending on what your doctor prescribes, the treatment may be taken as a pill or tablet, applied to the skin as a cream or a skin patch, or injected by a health care professional.
There are several drugs approved to treat incontinence — but medication may not be the first or best means of treating your condition. You should talk with your doctor about whether medication is an option to treat your urinary incontinence.
- Botox (onabotulinumtoxin A)
- Cymbalta (duloxetine)
- Detrol (tolterodine tartrate)
- Ditropan XL (oxybutynin chloride)
- Enablex (darifenacin)
- Myrbetriq (mirabegron)
- Oxytrol (oxybutynin)
- Tofranil (imipramine)
- Topical estrogen
- Toviaz (fesoterodine)
- Trospium chloride
- Vesicare (solifenacin)
It’s important to check the Medicare Advantage or Medicare Part D formulary — the list of covered medications — if you have a Medicare Part D plan or a Medicare Advantage plan. You can do this by contacting your plan’s administrator.
If your prescription is not covered, you may have to pay full price for it. Not all drugs are covered by every plan. But if one drug is not covered, another drug in the same class should be.
Does Medicare Cover Botox for Incontinence Treatment?
While Medicare does not cover Botox for cosmetic surgery, Medicare will cover it for medically necessary procedures. (Medicare considers a procedure medically necessary if it is used to prevent or treat a health condition.) Botox can be used to treat urinary incontinence and a handful of other medical conditions.
Original Medicare and Medicare Advantage plans will cover Botox treatments for an overactive bladder if your doctor deems the treatment medically necessary to treat the condition.
If your doctor recommends Botox treatment, it is a good idea to get preauthorization from Medicare or your Medicare Advantage plan’s administrator beforehand. That way, you won’t be stuck with a surprise medical bill.
9 Cited Research Articles
- Mayo Clinic. (2020, August 11). Bladder Control: Medications for Urinary Problems. Retrieved from https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220
- Vesiflo. (2020, June 17). Vesiflo Announces Medicare Coverage of the inFlow Device for Women. Retrieved from https://www.prnewswire.com/news-releases/vesiflo-announces-medicare-coverage-of-the-inflow-device-for-women-301078645.html
- National Institute of Diabetes and Digestive and Kidney Diseases. (2018, June). Treatments for Bladder Control Problems (Urinary Incontinence). Retrieved from https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/treatment
- National Institute on Aging. (2017, May 16). Urinary Incontinence in Older Adults. Retrieved from https://www.nia.nih.gov/health/urinary-incontinence-older-adults
- U.S. Centers for Medicare & Medicaid Services. (1996, October 7). National Coverage Determination (NCD) for Incontinence Control Devices (230.10). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=241&ncdver=1&bc=BAAAEAAAAAAA&
- Blue Cross Blue Shield of Massachusetts. (n.d.) Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence. Retrieved from: https://www.bluecrossma.com/common/en_US/medical_policies/523%20Transvaginal%20and%20Transurethral%20Radiofrequency%20Tissue%20Remodeling%20for%20Urinary%20Stress%20Incontinence%20prn.pdf
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Procedure Price Lookup. Retrieved from https://www.medicare.gov/procedure-price-lookup/
- Aeroflow Urology. (n.d.). What Does Medicare Cover for Catheters? Retrieved from https://aeroflowurology.com/blog/what-does-medicare-cover-for-catheters
- Mayo Clinic. (n.d.). Urinary Incontinence. Retrieved from https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814