Is Medicare responsible for reimbursement of PureWick external urinary catheters?
Managing Incontinence with PureWick:
Curious about urinary-wicking devices? One such innovation, the PureWick system, caters specifically to females for use during sleep or rest. This product includes an external catheter extending from the vulva to the buttocks, connected to a tube leading to a collection container that can be placed on a nightstand or table.
In a game-changing move, Medicare now covers the PureWick system under the durable medical equipment (DME) benefit of Part B, as per a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS).
Sex and gender exist on spectrums. This article uses the terms "male," "female," or both to refer to sex assigned at birth. Learn more about it.
Understanding Medicare Coverage for PureWick
Medicare Part B, which covers essential medical items under DME like oxygen supplies, walkers, and hospital beds, offers coverage for qualifying devices as long as a Medicare-enrolled doctor or healthcare professional prescribes them for home use. DME also encompasses external catheters like the PureWick system.
However, Medicare will not approve coverage if an individual uses an indwelling catheter simultaneously. Additionally, monthly limitations apply, with Medicare allowing no more than one metal cup or pouch per week for female catheters. In a hospital setting, catheters are covered by Part A.
What Does Medicare Pay for PureWick?
Without insurance, a box of 30 PureWick catheters typically costs around $209. Benefiting from bulk purchases can help save money. In 2025, Medicare enrollees must meet the annual deductible of $257 and pay a monthly premium of $185. Once eligibility criteria are met, Part B covers 80% of approved treatments or services.
For more details about Medicare terms like out-of-pocket costs, premiums, deductibles, coinsurance, and copayments, refer to the glossary below.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay when Medicare doesn't cover the full cost or offers partial coverage for their treatments. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the monthly amount of money someone pays for Medicare coverage.
- Deductible: This is an annual amount a person must spend before Medicare starts covering their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must personally cover.
- Copayment: This is a fixed dollar amount a person pays when receiving specific treatments, often applicable to prescription drugs.
While there is potential for Medicare coverage for PureWick, the specifics and extent of this coverage may vary based on individual circumstances. For the most accurate and personalized information, contact Medicare directly or use resources like RA Fischer for insurance guidance.
Enrichment Insights:
- As of 2025, Medicare's coverage and costs for PureWick external catheters may vary based on recent rulings and ongoing guidelines.
- Although Medicare covers the PureWick system under DME, there might be specific limitations or conditions for coverage that could make the system ineligible for Medicare reimbursement.
- Companies like RA Fischer offer assistance with insurance coverage for medical supplies, including PureWick, potentially helping to simplify accessing benefits and understanding coverage.
- Medicare Part B, which covers various medical items under Durable Medical Equipment (DME), now provides coverage for the PureWick system as per a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS).
- The PureWick system, a device catering to female urinary incontinence during sleep or rest, is now eligible for coverage under Medicare's DME benefit.
- However, Medicare will not approve coverage if an individual uses an indwelling catheter simultaneously, and monthly limitations apply, with Medicare allowing no more than one metal cup or pouch per week for female catheters.
- Typically costing around $209 for a box of 30 PureWick catheters, Medicare enrollees must meet the annual deductible of $257 and pay a monthly premium of $185 in 2025, with Part B covering 80% of approved treatments or services.
- For individuals seeking specific information regarding Medicare's terms and coverage for the PureWick system, resources like RA Fischer are available to offer guidance on insurance coverage for medical supplies.
- Given the potential for Medicare coverage for PureWick, it is crucial to contact Medicare directly or use resources like RA Fischer to obtain accurate and personalized information.
