Article Detail - JA DME

For all DMEPOS items, the initial justification for medical need is established at the time the item(s) is first ordered. Beneficiary medical records demonstrating that the item is reasonable and necessary are prepared just before, or simultaneously with, the initial prescription.

Once the initial medical need has been established, unless continued coverage requirements are specified in the Local Coverage Determination (LCD), an ongoing need for urological supplies to drain or collect urine is assumed for an individual with permanent urinary incontinence or retention. There is no requirement for further documentation of continued medical need if the beneficiary continues to meet the prosthetic device benefit.

The Noridian Urological Supplies webpage has additional information about urological supplies, including the LCD L33803 and Policy Article A52521.