Article Detail - JA DME
External Catheters and Urinary Collection Devices
Male External Catheters (Condom-Type) and Female External Urinary Collection Devices are covered for beneficiaries with permanent urinary incontinence when used as an alternative to an indwelling catheter.
Utilization Guidelines
For male external catheters (A4349), the general allowance is up to 35 per month. Any usage beyond this must be supported by documentation of medical necessity.
Male external catheters or female external urinary collection devices are not considered reasonable and necessary if the beneficiary also uses an indwelling catheter.
Specialty Catheters
Specialty male external catheters (A4326), including those that inflate or have a faceplate or extended wear systems, are covered only with documentation substantiating their medical necessity. Without documentation of medical necessity, claims will be denied as not reasonable and necessary.
Female External Urinary Collection Devices
More than one meatal cup (A4327) per week or more than one pouch (A4328) per day is deemed not reasonable and necessary.
More information can be found in the Local Coverage Determination (LCD) L33803.
