May 22, 2008
Medicare Changes Reimbursement Policy on Intermittent Catheterization
The Centers for Medicare and Medicaid Services (CMS) has changed its reimbursement policy on intermittent catheterization.  

Washington, D.C. – On April 1, 2008, the Centers for Medicare and Medicaid Services (CMS) changed its reimbursement policy on intermittent catheterization. The previous policy allowed reimbursement for only one intermittent catheter per week unless an individual user could prove the existence of at least 2 urinary tract infections in the course of one calendar year. The revised policy now allows reimbursement for up to 200 catheters per month per individual which means no re-use.

This change was advocated for by medical equipment companies, health organizations, and universities which saw the manufacturer’s term “single-use” to mean that the sterile catheter should be used one time and then discarded, not thoroughly cleaned for further catheterization use which is what many users were forced to do.

Among the advocates for change were Hollister Incorporated and the Coloplast Corporation, both suppliers of intermittent catheters, who began work on changing the policy in 2005. In March 2007, Hollister put together requirements for reconsideration of the existing policy and approached CMS with them. In June 2007, CMS indicated that they would not make the change, citing the long-existing policy’s effectiveness.

Undeterred by CMS’ firm stance, Hollister and Coloplast continued their efforts for sterile intermittent catheter change and solicited letters from organizations such as the Spina Bifida Association, the University of Miami School of Medicine, the Infectious Diseases Society of America (IDSA), and the National Multiple Sclerosis Society. These groups wholeheartedly joined the call for change as they all had grown weary of complaints from individuals regarding the substandard “re-use policy.”

“We worked diligently to get Medicare to reconsider their existing policy which had been in effect for decades to accurately reflect the true meaning of “single-use devices” as those that should not be re-used in any setting,” said Russell Miller, Director of Reimbursement Strategy and Services for Coloplast Corporation.

In November 2007, the Veterans Administration (VA) also developed a similar argument based on the Food and Drug Administration’s (FDA) policy that urinary catheters are considered single-use devices. The VA cited that manufacturers of catheters specifically identified them as single-use. They continued to argue that until manufacturers specifically changed labeling for urinary catheters, there was no policy interpretation that would allow the re-use of urinary catheters. This substantiated their claim that patients should be provided with an adequate number of sterile catheters to use with each catheterization.

“The VA’s argument helped our cause in bringing about change, and the new Medicare policy that went into effect in April is in compliance with all individuals’ needs,” said Deanna Eaves, Senior Reimbursement Manager at Hollister Incorporated.

Ultimately, the new policy better supports an individual’s desire to void their bladder with a new catheter on a more consistent basis than once a week. Both companies and the supporting organizations are pleased with this outcome. Hollister and Coloplast continue to work vigilantly on intermittent catheterization policies across the U.S. for patients needing such quality care.

For more information on the reimbursement policy change log on to www.medicarenhic.com.

The Spina Bifida Association is the nation’s only national voluntary health agency dedicated to serving the needs of the Spina Bifida Community. Its programs give hope and strength to more than 250,000 people whose lives are touched by this disabling birth defect. One of the SBA’s most vital functions is to communicate to the 65 million women of childbearing age the importance of daily folic acid intake to reduce the risk of neural tube defects such as Spina Bifida. For more information, visit www.spinabifidaassociation.org or call 800-621-3141.