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Catheter Referral Documentation Guide
A guide to the information your office may need when referring a patient to 180 Medical for catheter supplies.
Before You Submit a Catheter Referral
Here's a quick checklist of what should typically be included in your patient's catheter referral before submitting.
- Patient's contact and insurance information
- A complete, signed prescription or Standard Written Order (SWO)
- Supporting clinical documentation, such as recent signed progress notes (when required by the patient's insurance plan)
What to Include in a Patient Referral & Why
You work hard to make sure your patients have what they need. Our job at 180 Medical is to handle each referral you send us with the same level of care.
We know it can feel like a hassle to gather all the required urology documentation, but sending a complete referral helps us provide your patients' prescribed supplies while adhering to applicable Medicare, insurance, and accreditation requirements. We're here to answer questions and make the process easier.
Here are the three main types of information to include in your catheter patient referral.
1. Patient's Contact and Insurance Information
This part of the referral helps us get in touch with the patient to go over their needs and confirm the order.
Their insurance information helps us verify benefits, determine how the prescribed catheter supplies may be covered, and let your patient know about any expected out-of-pocket costs before the first order ships.
- Patient's full name
- Date of birth
- Address
- Phone number or other preferred contact information
- Designated point of contact, if applicable
- Primary insurance information
- Secondary or supplemental insurance information, if applicable
2. A Prescription or Standard Written Order
A complete prescription or Standard Written Order (SWO) should be signed and identify the patient, prescriber, supplies ordered, and quantity needed.
Required Order Information
- Patient's name
- Order date
- Urological diagnosis
- Frequency & quantity to dispense
- Authorized prescriber's name and NPI
- Prescriber's signature and date of signature
Helpful Facility Contact Information
- Facility name, address, and phone number
- Name of person sending referral
Catheter Order Details
- Catheter type prescribed (uncoated, coated hydrophilic, or catheter with insertion supplies)
- French size
- Catheter length
- Straight or coudé tip
- Catheterization frequency
- Number of refills
- 90-day supply authorization, if the patient is eligible to receive up to a 3-month supply at a time
Make Sure the Order and Supporting Notes Agree
Details like the catheter type, frequency, quantity needed, diagnosis, and length of need should match. Catching differences now may save your office from having to send additional paperwork later.
3. Supporting Clinical Documentation
Clinical notes may be needed depending on the patient’s insurance, medical needs, and the type of catheter prescribed.
For traditional Medicare referrals, include current, signed clinical notes that support the patient’s need for intermittent catheterization. Medicare Advantage, Medicaid, and some commercial plans may have similar requirements.
What the Clinical Notes Should Support
Ongoing or Permanent Need
Document that the condition requiring intermittent catheterization is expected to be long-term or indefinite.
Urological Diagnosis
Identify the urological diagnosis or condition that supports the patient’s need for intermittent catheterization.
Catheterization Frequency
Document how often the patient has been instructed to catheterize. The frequency in the notes should support the quantity ordered.
Relevant Urological History
Include relevant clinical details showing why intermittent catheterization is needed, such as the condition’s duration, clinical course, functional limitations, or prior treatment.
Additional Documentation for Coudé Catheters
A coudé catheter has a curved tip that may help when a patient cannot pass a straight-tip catheter.
If a coudé catheter is prescribed, the supporting documentation should explain why a catheter with a straight tip cannot be used and why a coudé insertion tip is medically necessary.
What to Document
- If the patient is unable to pass or use a straight-tip catheter
- The clinical reason a coudé tip is needed
- Any relevant condition supporting that need
What Documentation Does Each Insurance Type Require?
Requirements vary by insurance plan. If you're not sure what may be required, send the information you have, and we'll let you know if anything else is needed for your patient's referral.
- Medicare: Include signed progress notes that support the patient's need for the prescribed catheter supplies. Additional documentation may be needed for coudé catheters or closed system catheters with insertion supplies.
- Private or Commercial Insurance: Many plans only require a complete prescription, while others may need clinical notes, medical-necessity documentation, or prior authorization.
- Medicaid: Requirements vary by state and plan. Some Medicaid programs may follow documentation guidelines similar to Medicare. Other plans may require medical-necessity documentation or prior authorization.
Medicare Documentation for Closed System Catheters
Medicare may cover a sterile intermittent catheter kit, often referred to as a closed system catheter, when the patient meets additional coverage criteria.
A patient may meet Medicare's additional coverage criteria if they have one of the following documented circumstances:
- Have a documented spinal cord injury at any level
- Reside in a nursing facility
- Are immunosuppressed, including certain patients receiving immunosuppressive therapy or chemotherapy, patients with AIDS, or certain drug-induced immunosuppressed states
- Have radiologically documented vesico-ureteral reflux while using intermittent catheters
- Have at least two qualifying documented recurrent urinary tract infections within 12 months while practicing sterile intermittent catheterization
2026 Medicare Coverage Update for Spinal Cord Injured Patients
Patients with a documented spinal cord injury at any level may now qualify for coverage of prescribed closed system catheters with insertion supplies.
Qualifications for Recurrent Urinary Tract Infections (UTIs)
- Patient was on a program of sterile intermittent catheterization with sterile lubricant packages. Patients washing and reusing catheters or using tubes of lubrication do not qualify
- Two urine culture lab reports within the last 12 months. Cultures must be at least two weeks apart, and both lab reports must show culture growth greater than 10,000 CFU (colony-forming units).
- At least one concurrent symptom documented and dated within one week and specifically tied to the qualifying urine culture lab report
Qualifying Concurrent Symptoms
Each qualifying infection must include at least one of the following signs, symptoms, or laboratory findings at the same time as the positive urine culture:
- Fever greater than 100.4°F
- Systemic leukocytosis
- Change in urinary urgency, frequency, or incontinence
- New or increased autonomic dysreflexia, such as sweating, bradycardia, or elevated blood pressure
- Physical signs of prostatitis, epididymitis, or orchitis
- Increased muscle spasms
- Pyuria greater than 5 white blood cells per high-powered field
Helpful Documentation to Include
When referring a patient who may qualify due to recurrent UTIs, include available records showing:
- Dates of the qualifying infections
- Urine culture results
- Relevant signs, symptoms, or laboratory findings documented at the time of each infection
- The catheter and sterile lubricant used when the infections occurred
- Confirmation that the infections occurred within the required 12-month period
Other Qualifying Circumstances
Immunosuppression
Include clinical documentation identifying the condition, treatment, or medication supporting the patient’s immunosuppressed status.
Vesico-Ureteral Reflux
Include the radiology report or other medical record documentation establishing reflux and that the patient uses intermittent catheterization.
Nursing Facility Residence
Include medical records or facility documentation supporting the patient’s residence in a nursing facility.
Quick Reference: Daily Frequency and Monthly Quantity to Dispense
The quantity ordered should reflect the patient’s prescribed frequency and be supported by the clinical notes.
Use this guide to calculate the quantity needed for a 30-day supply.
What if my patient needs more than 200 catheters per month?
Medicare considers 200 intermittent catheters per month the usual maximum. In certain medically necessary situations, a patient may qualify for a higher quantity with supporting documentation.
Some commercial plans may cover more than 200, depending on their guidelines.
Disclaimer: The requirements described on this page can be found in the Medicare Local Coverage Determination (LCD) for Urological Supplies (L33803). This information is provided for reference only and is not intended as advice or instruction on how to complete a patient’s detailed written order or clinical notes. Coverage and documentation requirements may vary by insurance plan.
Ready to Send in Your Catheter Referral?
You can submit your referral online using E-Script, or download the referral form and fax it to (888) 718-0633 or email it to referrals@180medical.com.
Common Questions About Catheter Referrals
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