Inquiring about Medicare coverage for PureWick external catheters?
Managing Female Urinary Incontinence Just Got a Boost with PureWick!
Say goodbye to the hassle of managing nighttime incontinence with the latest innovation, the PureWick system. Designed especially for ladies, this system includes an external catheter that conveniently extends from the vulva to the buttocks, connecting to a tube leading to a collection container. You can easily place this container on a nightstand or table, providing a worry-free sleeping experience[2].
Now, thanks to a groundbreaking 2024 decision by the Centers for Medicare & Medicaid Services (CMS), Medicare now covers the PureWick system under the durable medical equipment (DME) benefit of Part B[3]. This benefit covers a wide range of essential medical items like oxygen supplies, walkers, and hospital beds[4]. A Medicare-enrolled individual can receive a qualifying device if prescribed by a Medicare-registered doctor or healthcare professional for home use.
Under DME, external catheters now serve as alternatives to indwelling catheters for individuals with permanent urinary incontinence, and, as of 2024, the PureWick system is included in this coverage. However, keep in mind that Medicare won't approve coverage if an individual also has an indwelling catheter[5]. Additionally, Medicare limits female catheter usage to no more than one metal cup or pouch per week[6]. In a hospital setting, catheters will be covered by Part A[7].
So, how much will Medicare pay for PureWick? According to the manufacturer's website, a box of 30 catheters typically costs approximately $209 for those without insurance[8]. But remember, purchasing in bulk can lead to savings.
As of 2025, eligible Medicare Part B enrollees are required to meet an annual deductible of $257 and pay a monthly premium of $185. Once they fulfill these conditions, Part B will cover 80% of the approved treatments or services[9].
In most cases, people are exempt from Part A premiums, but they must meet a deductible of $1,676, after which Part A will cover their hospital stay, as well as any necessary medical devices during that period, entirely for the first 60 days[10].
Medicare Advantage (Part C) plans are private plans that must provide the same benefits as Original Medicare, but the premiums, deductibles, and coinsurance vary depending on the plan[11].
A Quick Note About Terms:
- Out-of-pocket cost: The amount someone must pay for care when Medicare does not pay the total amount or offer coverage[12].
- Premium: The amount of money someone pays each month for Medicare coverage[13].
- Deductible: The annual amount someone must spend out-of-pocket within a certain period before Medicare starts paying their treatments[14].
- Coinsurance: The percentage of treatment costs someone must self-fund[15].
- Copayment: A fixed dollar amount someone with insurance pays when receiving certain treatments[16].
[1] Source: CMS, "National Coverage Determination for Intermittent Catheters (NCD 240) - Review of Bulletin condemning landmark 2024 CMS Ruling"[2] PureWick: How it Works, [Online]. Available: https://www.purewick.com/pages/how-it-works[3] CMS, "2024 HCPCS Code Changes", [Online]. Available: https://www.cms.gov/medicare/coding/hcpcs-code-contained- Within-chapter-70-list-explanatory-notes-effective-november-1-2023[4] Medicare, "What's Covered", [Online]. Available: https://www.medicare.gov/what-medicare-covers/what-s-covered/durable-medical-equipment-dme[5] CMS, "Medicare Benefit Policy Manual - Intermittent Catheters"[6] CMS, "National Coverage Determination for Intermittent Catheters (NCD 240) - Review of Bulletin condemning landmark 2024 CMS Ruling"[7] CMS, "Medicare Benefit Policy Manual - Intermittent Catheters"[8] PureWick: Pricing, [Online]. Available: https://www.purewick.com/pages/pricing[9] Medicare, "Understanding Your Costs"[10] Medicare.gov, "Medicare Coverage for Medical Equipment and Supplies in Hospitals", [Online]. Available: https://www.medicare.gov/ PublishCenter/ Glossaries/ Medicare-Glossary/Member-Glossary-TermDetail.aspx?GlossaryID=Doc Glossary&td=452[11] Medicare, "Private-Fee-for-Service (PFFS) Plans"[12] Medicare, "Know Your Medicare Costs"[13] Medicare, "Medicare Part B Premiums"[14] Medicare, "Understanding Your Costs"[15] Medicare, "What's a Coinsurance Amount?"[16] Medicare, "Understanding Your Costs"
Sex and Gender:
Sex and gender exist on spectrums. This article uses the terms "male," "female," or both to refer to sex assigned at birth. Learn more.
Update Notice:
The information provided in this article is based on the latest available resources at the time of writing. This text will be continuously updated to reflect any changes in policies, regulations, or pricing.
Disclaimer:
This article is intended to provide you with general information and guidance about managing incontinence and understanding the coverage by Medicare Part B. It is not intended to replace professional medical advice. Always consult a healthcare professional before making decisions about medical devices, treatments, or services.
- As of 2024, the Centers for Medicare & Medicaid Services (CMS) has made a groundbreaking decision to cover the PureWick system under the durable medical equipment (DME) benefit of Part B, joining other essential medical items like oxygen supplies and hospital beds.
- This coverage expansion includes external catheters as alternatives to indwelling catheters for individuals with permanent urinary incontinence, and PureWick, effective from 2024, is now part of this coverage.
- However, Medicare won't approve coverage if an individual also has an indwelling catheter, and the female catheter usage limit is set to no more than one metal cup or pouch per week.
- In 2025, eligible Medicare Part B enrollees will be required to meet an annual deductible of $257 and pay a monthly premium of $185 before receiving 80% coverage of the approved treatments or services—with PureWick now among these treatments for female health needs.
- As with other medical devices, the out-of-pocket cost for PureWick can be reduced through utilizing Part B coverage, though purchasing in bulk can lead to additional savings.
- It's essential to recognize the various costs associated with Medicare, including premiums, deductibles, and coinsurance, and, when applicable, understand the coverage provisions in the hospital setting via Part A.
