For those who are new to using catheters, it might come as a surprise just how many types of catheters and catheter brands are on the market. In addition to catheters designed specifically for males, females and even children, there are other options available, such as coated and uncoated catheters, catheters for enlarged prostates, and advanced products such as closed system catheters. In this article we’ll focus on closed system catheters, explaining their design and benefits, and then also what qualifies individuals to receive closed system catheters under Medicare guidelines.
What is a closed system catheter?
A closed system catheter is a type of intermittent catheter designed to reduce the risk of bacterial contamination. The closed system catheter contains a pre-lubricated or hydrophilic catheter housed inside of a sterile collection bag. During use, the catheter is pushed out of the bag directly into the urethra. This way, the fingers are never directly placed onto the catheter when inserting. Due to its special design, it is referred to as being “touchless” system.
Examples of touchless closed catheter systems are the Hollister Vapro™ Plus Pocket catheter, Cure Catheter® Closed System, GentleCath™ Pro Closed-System and the Coloplast SpeediCath Compact Male Catheter.
Some brands of closed system catheters also come with antiseptic wipes to disinfect hands and the urethral opening, gloves, and a disposable sterile underpad that can be placed across the lap or on another surface to create a clean workspace.
Convenience
An added benefit of many closed system catheters is the convenience of having a urine collection bag attached to the catheter. This eliminates the need for a separate urine collection container or dependence on toilet access for cathing. With a closed system and urine collect bag, you can cath anywhere and discreetly collect the urine in the attached bag. Then the entire system can be discarded later. Many people find closed system catheters especially helpful while traveling or in situations where bathrooms may not be readily accessible.
Insurance Coverage
If you have traditional Medicare, certain criteria must be met to receive coverage for closed system catheters. Some medical conditions are likely to qualify you for closed system catheters. These medical conditions include:
- Quadriplegia or spinal cord injury above the T3 level with evidence of immunosuppression.
- HIV/AIDS diagnosis.
- History of organ transplant.
- A diagnosis of vesicoureteral reflux (VUR). This is a condition where your urine backs up into your kidneys.
- Currently receiving medical treatment for cancer, such as chemotherapy, radiation, or other anticancer medications.
- Being female with a spinal cord injury who is pregnant. Closed systems are only covered for the duration of pregnancy.
- Long-term use of systemic immunosuppressant drugs.
- Immunosuppressant drugs are commonly prescribed for autoimmune conditions such as Crohn’s disease, lupus, rheumatoid arthritis, or lung conditions such as COPD.
- Common drugs from this class include corticosteroids (prednisone), biologics such as adalimumab (Humira®) or infliximab (Remicade®), calcineurin inhibitors such as tacrolimus (Envarsus XR® or Protopic) or cyclosporine (Gengraf®, Neoral® or Sandimmune®).
- History of recurrent urinary tract infections (UTI) while using other types of intermittent catheters.
- For Medicare to recognize that you have recurrent urinary tract infections, you will need specific documentation from your doctor. You must get these documents 30 days apart within a 12-month period to “prove” you have having recurrent UTI.
- This documentation consists of a doctor’s office note describing your physical symptoms of UTI plus urinalysis labs showing that there are at least 10,000 units of bacteria in your urine. Qualifying physical UTI symptoms include fever, abdominal or flank pain, needing to urinate more often, new-onset urinary incontinence, nausea/vomiting, chills, or increased muscle spasms. Most Medicare managed plans also follow these guidelines; however, the plan may have their own criteria.
If you have private insurance or a Medicaid plan, requirements for closed system catheters may be different. Some plans do not have any special requirements for closed system catheters. At ABC Medical, we have insurance experts that can guide you and your doctor through the insurance requirements for product coverage. We will obtain the documents on your behalf and submit to your insurance.
Call us today at 866-871-0019 to discuss closed system catheter insurance coverage options.
Disclaimer: This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. For medical advice, please speak with your healthcare provider.
