What documentation is required when referring Medicare patients?

Ready to start referring your Medicare patients to 180 Medical? Medicare has certain requirements for proper documentation in order to cover your patient's catheter supplies, but don't worry. 180 Medical is here to help walk you through the process!

Medicare will allow insured patients up to 200 intermittent catheters per month for one-time, sterile use catheterization with proper documentation and a matching written order. Get the details below, and start referring now with 180 Medical's secure, easy-to-use E-Script platform.

Medicare Documentation That May Be Required for Referrals

1. A Detailed Written Order (Prescription or Plan of Care)

You will need to provide a valid prescription (Plan of Care) with the diagnosis, the type of supplies needed, and how often per day/week/month your patient must use them.

2. Progress Notes

Medicare requires supporting documentation in the form of written progress notes or doctor's notes. This documentation must indicate the PDF, or:

• Permanence of the condition
• Diagnosis
• Frequency of catheterization

What if my patient requires a coudé tip catheter?

If your patient requires a coudé tip catheter, this must also be documented in the progress notes. Document why a straight catheter doesn't work and why the patient needs a coudé tip.

What if my patient requires a closed system catheter?

Medicare primarily only covers straight, uncoated catheters and lubrication. However, there are circumstances in which they may approve closed-system catheters.

One possible option is if your patient has evidence of two distinct recurrent urinary tract infections (UTIs) within 12 months while on a program of sterile intermittent catheterization (using one catheter and one sterile lubricant packet one time and then throwing it away). Documentation must show that sterile use was happening at the time of the infections.

Also, Medicare-insured patients with a T3 or higher spinal cord injury are now eligible. Make sure their medical records document the level of their spinal cord injury.  

What if my patient requires a coudé tip catheter?

If your patient requires a coudé tip catheter, this must also be documented in the progress notes. Document why a straight catheter doesn’t work and why the patient needs a coudé tip.

What if my patient requires a closed system catheter?

Medicare primarily only covers straight, uncoated catheters and lubrication. However, there are circumstances in which they may approve closed-system catheters.

One possible option is if your patient has evidence of two distinct recurrent urinary tract infections (UTIs) within 12 months while on a program of sterile intermittent catheterization (using one catheter and one sterile lubricant packet one time and then throwing it away). Documentation must show that sterile use was happening at the time of the infections.

Under current Medicare policy, a spinal cord injury at any level may meet the applicable coverage criteria for receiving closed system catheter kits.