If you or someone you love and support uses intermittent catheters, Medicare typically covers up to 200 single-use catheters a month. But it’s important to note that the number of covered catheters isn’t automatic, and it’s not always as simple as “Covered!”
How many catheters you can get through Medicare depends on your prescription, the catheter type, and whether you are on Medicare or Medicaid.
Many never explore just how many catheters they are covered for, because they simply assume that whatever they get each month is the maximum amount offered.
But there’s a chance that the catheters you’re currently receiving were a number picked when the account was initially set up.
Here’s what you need to know about how many you may be qualified to receive each month (and how to make sure you are getting what you qualify for!)
New to Medicaid-qualifying catheters and other incontinence products? Start with our guide to insurance-covered catheters to see the first steps you need to take!
How Many Intermittent Catheters Does Medicare Cover Each Month?
Medicare Part B covers up to 200 single-use catheters each month. But that number is a ceiling, not a guaranteed amount that everyone on Medicare Part B automatically receives.
The number you may get under Medicare depends on a few factors:
- How often your doctor prescribes catheterization: If your prescription calls for self-catheterization twice a day, you may find your monthly coverage is closer to 60. The quantity is often built around your prescribed need.
- The makeup of your catheter supplies: The 200-unit cap is also a combined limit. That means it covers your intermittent catheters as well as any catheterization kits (not 200 of each separately).
- Other necessary supplies: Coudé tip and closed-system catheters may be covered by Medicare, but they often require documentation of medical necessity in your medical record. That could mean a note about an enlarged prostate, urethral scarring, or another reason that a straight catheter doesn’t work well for your particular circumstance.
Catheter Types and Coverage at a Glance
Coverage looks different depending on the exact type of catheter you use, so here’s a quick side-by-side breakdown.
| Catheter Type | What Medicare Covers | What Medicaid Covers | Important Details |
| Intermittent catheters (standard, single-use) | Covers up to 200 single-use catheters a month, combined with other intermittent catheter codes. | Varies by state. There is no single national number. | Your true monthly number is based on how often catheterization is prescribed each day, not a flat 200 for everyone. |
| Coudé tip catheters | Covered within the same combined 200-unit monthly cap, not a separate allowance. | Varies by state. There is no single national number. | Requires documented medical necessity in your medical record, such as an enlarged prostate or urethral scarring. |
| Closed system / sterile catheter kits | Covered within the same combined 200-unit monthly cap, not a separate allowance. | Varies by state. There is no single national number. | Requires meeting one of Medicare’s specific criteria: living in a nursing facility, being immunosuppressed, or a recent history of recurrent UTIs while on intermittent catheterization. |
| Indwelling (Foley) catheters | Covers one catheter a month for routine maintenance. | Varies by state. There is no single national number. | More than one per month may be covered with documentation, such as malfunction, blockage, or a history of recurrent UTIs. |
Does Medicare Cover Indwelling (Foley) Catheters?
You’ll find that indwelling catheters work differently than other catheters. Medicare covers one indwelling catheter a month for routine maintenance. This is the standard allowance, not a starting number you can build up from.
As an indwelling catheter is designed to stay in place for a longer period of time, it is provided through routine care schedules rather than a running supply. More than one may be covered in a given month, but specific documentation is typically required.
Does Medicaid Follow the Same Catheter Limits?
Medicare’s number of covered catheters comes from a national policy. Medicaid works differently, as each state runs its own Medicaid program.
That means quantity limits, prior authorization rules, and catheter types covered can vary depending on the state (as well as plan to plan).
This is the gap that many don’t realize until they are missing essential supplies. And that’s why our team at UroStat can help you analyze your plan and state coverage to make sure you get the exact supplies you need.
Instead of guessing at what your specific state Medicaid plan allows, we can work with you to verify the coverage details and let you know the exact supplies you qualify for.
What if You Need More Catheters Than Your Plan Allows?
If you find that your current catheter allowance isn’t enough, you will want to start the conversation with your prescribing physician. Talk with your doctor about your situation, and work with them to document the medical reason why you need more catheters each month.
That documentation is key to allowing a supplier to request an exception to the standard quantity on your behalf.
While it doesn’t guarantee that you’ll get more each month, it’s the first step in making sure you’ve done your due diligence to get the supplies you need within your coverage.
The same goes for learning which limits apply to you in the first place. A quick call with an expert can confirm whether your plan follows Medicare’s numbers or your state’s Medicaid rules. You can even learn if a private insurance policy with its own terms may help you get what you need.
Get the Full Picture on Coverage with UroStat
You shouldn’t have to guess at what your coverage provides when it comes to essential healthcare supplies. Whether you’re choosing a supplier for the very first time or making sure you are getting what you qualify for, UroStat is here to help.
Call UroStat today at 888-845-8698, or click here to quickly check your eligibility online. We can help you determine your exact monthly allowance, intermittent or indwelling, and much more.
You care for your health. We will take care of the rest.