Medicare covers catheters and related supplies, but what you pay depends on which type of catheter you need and whether you have Original Medicare or a Medicare Advantage plan

If your doctor prescribes a catheter for medical reasons — whether temporary after surgery or ongoing due to a condition like spinal cord injury or urinary retention — Medicare Part B covers the cost of the catheter itself and the supplies you need to use it safely. You typically pay 20 percent of the approved amount after you meet your Part B deductible. The exact coverage and your out-of-pocket costs vary based on whether the catheter is intermittent (used several times a day) or indwelling (left in place continuously), and whether you get it through a medical supply company or a hospital.

The key to understanding your costs is knowing that Medicare treats catheters as durable medical equipment (DME), which means they fall under specific coverage rules. Your doctor must write an order stating medical necessity, and you must use a Medicare-approved supplier. If you use a non-approved supplier, Medicare will not pay, and you could be responsible for the full cost.

Key Takeaways

  • Medicare Part B covers catheters and catheter supplies when prescribed by a doctor for a medical condition, and you pay 20 percent of the approved amount after meeting your deductible.
  • You must obtain catheters from a Medicare-approved medical supply company; using an unapproved supplier means Medicare will not pay and you pay the full cost.
  • Intermittent catheters (used multiple times daily) and indwelling catheters (continuous) have different supply needs, and Medicare covers both types of ongoing supplies.
  • Medicare Advantage plans may cover catheters differently than Original Medicare, so you should check your plan documents or call your plan to confirm your costs.
  • Your doctor's order must document medical necessity; without it, Medicare will deny the claim.

How Medicare Part B covers catheter costs

Under Original Medicare, Part B pays 80 percent of the approved amount for catheters and catheter supplies after you have paid your annual Part B deductible (which is $240 in 2024, though this amount changes yearly). You are responsible for the remaining 20 percent. This coinsurance applies whether you need a single catheter or a month's supply of intermittent catheters.

The "approved amount" is what Medicare decides is reasonable for that item in your area — not necessarily what the supplier charges. If a supplier bills more than the approved amount, they cannot charge you the difference if they are Medicare-approved. This protection is one reason using an approved supplier matters.

If you have already met your Part B deductible earlier in the year (for example, through other medical services), you pay only the 20 percent coinsurance for catheters with no additional deductible. If you have not met it, you pay the full cost of catheters until the deductible is satisfied, then 20 percent after that.

Types of catheters Medicare covers

Medicare covers both intermittent catheters and indwelling catheters, along with the supplies needed for each. Intermittent catheters are inserted and removed several times a day — typically four to six times — and are used by people who can empty their bladder partially but not completely, or who cannot urinate on their own. Indwelling catheters (also called Foley catheters) stay in place continuously and drain into a bag; they are used after certain surgeries, for people with severe mobility limitations, or for those with conditions that make intermittent catheterization unsafe or impractical.

For intermittent catheters, Medicare covers the catheters themselves plus lubricant, collection bags, and other necessary supplies. The number of catheters covered per month depends on your medical need — your doctor's order should specify how many you require daily, and Medicare will cover that quantity. For indwelling catheters, Medicare covers the catheter, the drainage bag, leg bags for daytime use, and supplies like tape and antiseptic wipes.

Medicare also covers external catheters (condom catheters) for men who have urinary incontinence but can empty their bladder, as well as catheter-related items like irrigation supplies if your doctor prescribes them for medical reasons.

Finding a Medicare-approved supplier

You must order catheters from a Medicare-approved DMEPOS supplier (DMEPOS stands for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies). If you use a non-approved supplier, Medicare will not pay anything, even if your doctor prescribed the catheter. You will owe the full cost.

To find approved suppliers in your area, use the Medicare Supplier Directory at dmepos.cms.gov. You can search by ZIP code and type of equipment (catheters). The directory shows which suppliers are approved, their contact information, and whether they deliver to your address. Call a few suppliers to compare — they may have different delivery schedules, customer service hours, or how they handle refills.

When you contact a supplier, have your doctor's order ready. The supplier will verify that your doctor's prescription meets Medicare's medical necessity requirements and will handle submitting the claim to Medicare. You should receive your first shipment within a few days to a week, depending on the supplier's processing time.

What your doctor's order must include

Your doctor must write an order (sometimes called a prescription or certificate of medical necessity) that states why you need a catheter. Medicare requires the order to document a specific medical condition — such as spinal cord injury, urinary retention, post-surgical recovery, severe mobility impairment, or another condition that prevents normal urination. A vague order like "patient needs catheter" will not be enough; the order must connect your condition to the medical need for the catheter.

The order should also specify the type of catheter (intermittent or indwelling), the size or type if relevant, and how many you need per day or per month. If your needs change — for example, if you switch from intermittent to indwelling catheters — you need a new order from your doctor. Medicare may also ask your doctor to recertify your need periodically, especially if you have had the same prescription for a long time.

Medicare Advantage plan coverage for catheters

If you have a Medicare Advantage plan (Part C), your coverage for catheters is set by your specific plan, not by Original Medicare rules. Most Medicare Advantage plans do cover catheters, but your out-of-pocket cost, the suppliers you can use, and any prior authorization requirements may be different from Original Medicare.

Some Medicare Advantage plans require you to use suppliers within their network, while others allow any Medicare-approved supplier. Some plans may charge a copay instead of coinsurance, or may have different deductibles. A few plans may require prior authorization — meaning your doctor must get approval from the plan before you order catheters, or the claim could be denied.

The best way to know what your plan covers is to call the customer service number on your plan card and ask specifically about catheter coverage, your out-of-pocket cost, which suppliers are in-network, and whether prior authorization is needed. This conversation takes 10 minutes and can save you from unexpected bills.

Supplies beyond the catheter itself

Medicare covers not just the catheter but also the supplies you need to use it safely and hygienically. For intermittent catheters, this includes sterile lubricant packets, collection bags or containers, and antiseptic wipes. For indwelling catheters, Medicare covers the catheter, the drainage bag, leg bags for wearing under clothing during the day, tape, and irrigation supplies if medically necessary.

The quantity of supplies covered is based on your medical need as documented in your doctor's order. If you use six intermittent catheters per day, Medicare will cover six catheters per day plus the corresponding lubricant and wipes. If you need to change your indwelling catheter weekly, Medicare covers one catheter per week plus the related supplies for that frequency.

If you need supplies beyond what your doctor's order specifies, ask your doctor to update the order. Do not assume you have to pay out of pocket for extra supplies; Medicare may cover them if your medical condition justifies the need.

What happens if Medicare denies your claim

If Medicare denies a catheter claim, the supplier or your doctor's office will send you a notice explaining why. Common reasons for denial include: the doctor's order does not document medical necessity clearly enough, you used a non-approved supplier, the order has expired and needs recertification, or the quantity requested exceeds what Medicare considers medically necessary for your condition.

If you disagree with the denial, you have the right to appeal. The notice will explain how to file an appeal and the important date (usually 120 days from the date of the notice). You can ask your doctor to provide additional documentation of your medical need, or you can submit a written statement explaining why you believe the denial is incorrect. Many denials are overturned on appeal when the doctor provides clearer documentation.

If you have a Medicare Advantage plan and your claim is denied, the appeal process is slightly different — your plan will explain the steps in the denial notice. Contact your plan's customer service to ask about the appeal process if the notice is unclear.

Frequently Asked Questions

Do I have to pay anything out of pocket for catheters?

Yes, under Original Medicare you pay 20 percent of the approved amount after meeting your Part B deductible. Under a Medicare Advantage plan, your cost depends on your specific plan — it may be a copay, coinsurance, or nothing if you have already met your deductible. Contact your plan or supplier to find out your exact cost before you order.

What if my doctor prescribes catheters but I have not met my Part B deductible yet?

You pay the full cost of catheters until you have paid $240 (the 2024 deductible amount) toward your Part B services for the year. Once you reach that amount through any combination of medical services, you then pay 20 percent coinsurance for catheters and other Part B-covered items for the rest of the year.

Can I order catheters online from a non-Medicare supplier and have Medicare pay?

No. Medicare will only pay if you order from a Medicare-approved supplier. If you order from a non-approved supplier, Medicare will deny the claim and you will owe the full cost. Use the Medicare Supplier Directory to find approved suppliers near you.

How often can I get new catheters?

The frequency depends on your medical need as stated in your doctor's order. If you use intermittent catheters, Medicare typically covers a one-month supply based on how many you use per day. If you use indwelling catheters, Medicare usually covers one catheter per week or per month depending on your doctor's recommendation. Your supplier will handle the refill schedule based on your order.

Does Medicare cover catheter care training?

Medicare Part B covers catheterization training — teaching you how to insert, clean, and care for your catheter — when a doctor prescribes it and it is provided by a may have access to healthcare provider. This is billed separately from the catheter supplies themselves. Ask your doctor or supplier whether training is covered under your plan.