Catheters - Medicare Requirements Checklist

Medicare Billing for Catheters

Atlantic Healthcare Products is a durable medical equipment (DME) provider that specializes in catheter and urology supplies. We are experienced in Medicare billing and take care of all the paperwork for our patients in Palm Beach County. Medicare's Coverage criteria is complex, but we know how to navigate it to make sure our patients get the coverage they need. We work closely with patients, their doctors, and Medicare to make sure everyone is on the same page and that our patients can get the supplies they need. Contact us today if you or a loved one needs help with Medicare billing for catheters or any other DME needs.

Criteria and Medical Justification must be met for coverage.

Save time by filling out our basic patient information form. All we need is patient name, date of birth, contact information, address, insurance information and a brief description of what you are looking for. Once we receive your information, we will get the process started before you get to the store. Click on Patient Pre-Intake to get started.

The checklist below is derived from Medicare’s Coverage criteria for Urological Catheters. Without the below criteria being fully and legible documented in the physician's chart notes and Rx, Medical justification has not been met for the items requested.

Patient Medicare Requirements

Catheter Documentation Requirements for Medicare

Review of Face-to-Face Examination Chart Notes for Catheters

Criteria for Chart Notes for Internal Catheters:

▢ Medical records verify that the beneficiary has permanent urinary incontinence or permanent urinary retention – AND –

▢ The Impairment of urination is not expected to be medically or surgically corrected within 3 months – AND –

▢ Documentation of usage indicating description of the catheter and the usage.

• Up to 200/month

▢ Additional Documentation if prescribing for:

• Coude catheters:

• Medical records document the medical necessity of this type of catheter.

• Need to rule out why straight catheters cannot be used

• Sterile Intermittent Catheter Kits.

• There are several pathways for qualification, please call us at 561-290-1434

Detailed Written Order (DWO)- *** Please sign the attached Detailed Written Order **

▢ Beneficiary's name

▢ Physician’s Name

▢ Description of each item (“intermittent”; “Coude”; w/ French size; Lubricant)

▢ Specific Frequency of Use (3-4 times per day) (“prn” orders are not acceptable)

▢ Quantity to Dispense per month

▢ Refill frequency or # of Refills

▢ Signature of treating physician with date (Stamps are not acceptable)

• Physician’s Signature on written order meets CMS Signature Requirements.

Please fax your referrals and documentation to 561-290-1434

Need Catheters or Urology Supplies Today?

We have Urology Supplies available online. Visit one of our locations to see our in-stock supplies.

How Do I Get Medicare Catheter Coverage?

If you're a Medicare beneficiary in Palm Beach County and you need DME (durable medical equipment) like catheters or urology supplies, Atlantic Healthcare Products can help. We have experience with Medicare billing and we'll make sure that all the paperwork is taken care of. We'll also work with your doctor to make sure that Medicare's coverage criteria are met. So call us today and let us take the stress out of dealing with Medicare. We can be reached by chat, phone or just visit us at one of locations.

West Palm Beach: 561-964-6767

Boynton Beach: 561-733-2331