How Medicare covers PureWick and what you have to prove

Medicare Part B covers PureWick as durable medical equipment (DME) if your doctor writes an order saying you need it for medical reasons. Medicare will not pay based on convenience or preference alone. You need a documented medical condition — such as severe mobility limitations, incontinence, or a condition that makes traditional toileting unsafe — and your doctor must state that PureWick is medically necessary for your specific situation.

The coverage itself is straightforward: Medicare pays 80 percent of the approved amount after you meet your Part B deductible. You pay the remaining 20 percent. However, getting that initial approval requires paperwork in a specific order, and skipping steps or submitting incomplete forms will delay or deny your claim.

The process takes roughly four to six weeks from the time your supplier submits the paperwork to Medicare. During that time, you can use PureWick out of pocket, but you will not know whether Medicare will reimburse you until the decision comes back.

Key Takeaways

  • Your doctor must write a written order for PureWick and document the medical reason you need it — convenience or incontinence alone is not enough without supporting clinical notes.
  • You must use a Medicare-approved DME supplier, not buy PureWick directly from the manufacturer, or Medicare will not process the claim.
  • Medicare requires a Certificate of Medical Necessity (CMN) form completed by your doctor before the supplier can submit the claim.
  • You pay 20 percent of the approved amount after your Part B deductible; the exact cost depends on what Medicare allows in your area.
  • If Medicare denies the claim, you have the right to appeal within 120 days by submitting additional medical records or a letter from your doctor explaining why PureWick is necessary.

What your doctor needs to document before you order

Medicare does not accept a verbal order or a casual prescription. Your doctor must create a written order that includes the specific medical reason PureWick is necessary. Common reasons that Medicare accepts include severe urinary incontinence that cannot be managed by other means, mobility limitations that make toileting impossible or unsafe, or skin breakdown from prolonged use of traditional incontinence products.

The order should reference your diagnosis code and explain why PureWick is the appropriate treatment. For example, "Patient has Stage 3 pressure ulcers from prolonged catheter use and requires hands-free urine collection to prevent further skin damage" is stronger than "Patient has incontinence." Your doctor's clinical notes should match the order — if the notes do not mention PureWick or the medical reason for it, Medicare will ask for clarification.

Before you ask your doctor to write the order, gather your recent medical records showing your diagnosis and any treatments you have already tried. If you have used other incontinence products and they did not work, mention that. If you have pressure ulcers, skin infections, or mobility issues documented in your chart, those strengthen the case. Bring this information to your appointment so your doctor can reference it in the order.

Choosing a Medicare-approved DME supplier

You cannot buy PureWick directly from the manufacturer and submit the receipt to Medicare. You must order through a Medicare-enrolled DME supplier. Medicare will only process claims from suppliers who are registered with Medicare and meet specific requirements.

To find an approved supplier in your area, call Medicare at 1-800-MEDICARE or visit the Medicare Supplier Directory at dmepos.cms.gov. Search for suppliers near you and confirm they carry PureWick. When you call a supplier, ask whether they accept Medicare assignment — this means they agree to accept Medicare's approved amount as payment in full for the equipment, and you will not be billed more than your 20 percent coinsurance.

Once you choose a supplier, give them your doctor's written order. The supplier will then request the Certificate of Medical Necessity (CMN) form from your doctor's office. Do not submit the order to Medicare yourself — the supplier handles all the paperwork. Your job is to make sure your doctor completes the CMN and returns it to the supplier promptly.

The Certificate of Medical Necessity and claim submission

The Certificate of Medical Necessity (CMN) is a standardized form that your doctor must complete. It asks for your diagnosis, the reason PureWick is medically necessary, and confirmation that your doctor has examined you and determined this equipment is appropriate. The form is not optional — Medicare will not process a claim without it.

Your supplier will send the CMN form to your doctor's office. Ask your doctor's office how long it typically takes them to return completed forms — some offices turn them around in a few days, others take two weeks. If you do not hear back within a week, call and follow up. A delayed CMN delays your entire claim.

Once your doctor signs and dates the CMN, the supplier submits it to Medicare along with the order, your demographic information, and the claim for payment. Medicare then reviews the paperwork to confirm your doctor's medical reasoning is sound. If everything is complete and the medical necessity is clear, Medicare approves the claim and notifies both you and the supplier.

What happens after Medicare approves your claim

When Medicare approves the claim, the supplier ships the PureWick system to you. Medicare sends you an Explanation of Benefits (EOB) showing what they approved, what they paid, and what you owe. If you have already paid the supplier out of pocket while waiting for approval, the supplier will credit that amount toward your coinsurance or refund the difference.

PureWick is classified as a continuous-use item, meaning Medicare covers the initial system and replacement supplies for as long as your doctor says you need it. You will need a new written order from your doctor every 12 months for Medicare to continue covering supplies. Set a reminder to contact your doctor's office three months before your current order expires so there is no gap in coverage.

Keep all your Medicare paperwork — the order, the CMN, the EOB, and any receipts. If you ever need to appeal a denial or prove you have Medicare coverage for PureWick, these documents are your evidence.

What to do if Medicare denies your claim

Medicare may deny a claim if the medical necessity is not clear, the CMN is incomplete, or the supplier is not Medicare-enrolled. The denial notice will explain the reason. Read it carefully — different reasons require different responses.

If the denial is because the medical necessity was not documented well enough, ask your doctor to write a letter explaining in detail why PureWick is medically necessary for your condition. Include any new test results, imaging, or clinical notes that support the need. Have your supplier resubmit the claim with this additional documentation.

If the denial is because the supplier is not Medicare-enrolled, you will need to order through a different supplier. Contact the Medicare Supplier Directory again and choose another provider in your area.

You have the right to appeal any denial within 120 days of the denial notice. Your supplier can help you file the appeal, or you can contact Medicare directly at 1-800-MEDICARE. An appeal does not cost anything, and you can submit new medical evidence as part of the appeal.

Understanding your out-of-pocket costs

Your cost for PureWick through Medicare depends on two things: whether you have met your Part B deductible for the year, and what Medicare's approved amount is in your area.

If you have not met your Part B deductible (which is $226 in 2024, though this amount changes yearly), you pay the full approved amount until the deductible is satisfied. After that, you pay 20 percent of the approved amount. For example, if Medicare's approved amount for the PureWick system is $500 and you have already met your deductible, you pay $100 and Medicare pays $400.

The approved amount varies by region and by supplier. Two suppliers in different areas may bill different amounts, but Medicare only pays based on its approved amount for your location. Ask your supplier what the approved amount is before you order, so you know your exact cost.

If you have a Medigap or Medicare Advantage plan, your coinsurance may be covered in full or in part. Check your plan documents or call your plan's customer service to confirm what you will owe out of pocket.

Frequently Asked Questions

Can I use PureWick while I wait for Medicare to make a decision?

Yes. You can use PureWick when ready and pay out of pocket. Once Medicare approves the claim, the supplier will credit your out-of-pocket payment toward your coinsurance or refund the difference. Keep all receipts and documentation in case you need to prove payment.

What if my doctor says I need PureWick but Medicare says it is not medically necessary?

You can appeal the denial and ask your doctor to provide additional clinical evidence — such as notes about failed attempts with other products, pressure ulcers, or mobility limitations — that support the medical necessity. You have 120 days to file an appeal at no cost.

Do I need a new order every time I order replacement supplies?

No. Your original written order covers the initial system and supplies for 12 months. After 12 months, your doctor must write a new order for Medicare to continue covering supplies. Contact your doctor's office three months before the order expires to request a renewal.

Will Medicare cover PureWick if I have a Medicare Advantage plan instead of Original Medicare?

Medicare Advantage plans must cover all DME that Original Medicare covers, including PureWick. However, your out-of-pocket costs and the suppliers you can use may be different. Contact your plan directly to confirm coverage and find an in-network supplier.

What if the supplier I want to use is not Medicare-enrolled?

Medicare will not process a claim from a non-enrolled supplier. You must order through a Medicare-enrolled DME supplier. Use the Medicare Supplier Directory to find an approved supplier near you, or ask your doctor's office for a referral to a supplier they work with regularly.