While Medicaid covers many incontinence supplies for home use, Medicare is much more sparing in its coverage.

Medicaid covers miscellaneous incontinence supplies under a specific code, as well as the following: diapers, disposable underpads (or chux), incontinence diapers, pull-up briefs, and disposable liners or shields.

The following supplies are not covered by Medicaid: sanitary napkins, cosmetics, dentifrice items, tissues, non-ostomy deodorizing products, disposable wipes, shampoo, and general personal hygiene items. Keep in mind that these are guidelines only, as Medicaid coverage varies by state. More detailed information is included in your incontinence handout.

Medicare reimburses based on the basic threshold requirements, and DMERC medical policies include quantity limits for each item. And as with ostomy and other medical supplies, usage above the quantity limits set forth by Medicare require special documentation.

Medicare has specific guidelines that include allowable quantities of items that will be covered per billing period, and those are included in your handouts. Items like indwelling catheters, leg drainage bags, bedside bags, and supplies for intermittent catheterization are covered there.

Incontinence and PPS
In addition to the limits Medicare has set on specific quantities per month of certain items, providers must also take into account the DMERC rules regarding the bundling of incontinence supplies under PPS. This can make billing for these supplies a little more complicated. The DMERC medical policies include lists of codes that must be bundled in the billing. As an example, two bedside drainage bags per month are covered. However, if a catheter kit is provided at the same time as the drainage bag, the bundling rules require the provider to bill using a code for a kit with a drainage bag rather than billing the kit and bag separately. In a month in which one of these codes is billed, DMERC will ordinarily reimburse the provider only for one separately billed drainage bag. Medical supplies providers are very good at following the coverage guidelines and educating the patient as to how they work.

There are also guidelines for the intermittent irrigation of indwelling and external catheters. These guidelines are included in your handouts.

DMERC medical policies cover supplies for intermittent irrigation of indwelling catheters only when they are used on an as-needed basis due to an acute obstruction of the catheter. Routine intermittent irrigation and continuous irrigation as a primary preventive measure are considered medically unnecessary and will be denied. Supplies for continuous irrigation are covered only if there is a history of obstruction and the catheter cannot be kept open with intermittent irrigation. The medical record must contain documentation to the necessity for either intermittent or continuous irrigation. Medicare also covers male external catheters when used as an alternative to indwelling catheters by patients who have permanent urinary incontinence. Limits are 35 per month unless the medical record documents the necessity of greater use. Female external urinary collection devices are also covered under the same conditions, with coverage ordinarily limited to one metal cup per week or one pouch per day.