What Medicare covers for Purewick

Medicare Part B covers Purewick — a hands-free external catheter system for men — when a doctor writes an order for it and you meet specific medical requirements. The system collects urine without an indwelling catheter, which reduces infection risk for people with mobility problems, incontinence, or skin breakdown.

Medicare classifies Purewick as durable medical equipment (DME), the same category as wheelchairs, walkers, and oxygen machines. This means you pay 20% of the approved amount after you have met your Part B deductible. Medicare pays the remaining 80%.

The catch is that your doctor must document a medical reason — not convenience or preference — and you must use a Medicare-contracted DME supplier. Ordering from a non-contracted supplier means you pay the full cost out of pocket.

Key Takeaways

  • Medicare Part B covers Purewick as durable medical equipment when a doctor orders it for a covered medical reason.
  • You pay 20% of the Medicare-approved amount after meeting your Part B deductible; Medicare pays 80%.
  • Your doctor must document that you have a medical condition that makes the system medically necessary, not just convenient.
  • You must order through a Medicare-contracted DME supplier, or Medicare will not pay any portion of the cost.
  • Coverage includes the collection pouch and adhesive strips, but rental or purchase terms depend on your specific supplier agreement.

Medical reasons Medicare will cover Purewick

Medicare covers Purewick when you have a condition that makes traditional catheterization unsafe or impractical. The most common reasons are severe mobility limitations (such as from Parkinson's disease, advanced arthritis, or spinal cord injury), severe urinary incontinence that does not respond to other treatments, or skin breakdown in the genital area that would be worsened by an indwelling catheter.

Your doctor must write that the system is medically necessary for your specific condition. Medicare reviewers will check whether the reason matches their coverage rules. If your doctor straightforward writes "patient wants this" or "for convenience," the claim will be denied.

If you have had a recent hospitalization or skilled nursing facility stay where Purewick was used successfully, that history strengthens the case for coverage. Bring discharge papers or facility records to your appointment.

How to order Purewick through Medicare

Start by talking to your doctor about whether Purewick is appropriate for your condition. If your doctor agrees, ask them to write a detailed order that explains why the system is medically necessary for you. The order should go to a specific DME supplier — not directly to Purewick or a retail pharmacy.

Find a Medicare-contracted DME supplier near you by calling Medicare at 1-800-MEDICARE or searching the Medicare Supplier Directory online at dmepos.cms.gov. When you call suppliers, ask whether they carry Purewick and whether they are currently taking new Medicare patients. Some suppliers have waiting lists.

Once you have chosen a supplier, give them your doctor's order, your Medicare number, and your contact information. The supplier will submit the claim to Medicare on your behalf. You should receive the equipment within one to two weeks if the claim is approved without review.

What happens if Medicare denies the claim

If Medicare denies your claim, the DME supplier must send you a notice explaining the reason. Common denials happen when the doctor's order does not clearly state a medical reason, when the condition listed is not on Medicare's covered list, or when the supplier was not contracted with Medicare.

You have the right to ask your doctor to provide more detailed medical information and resubmit the claim. This is called a reconsideration. Your doctor can write a letter explaining your specific symptoms, test results, or past treatments that show why Purewick is medically necessary for you.

If the reconsideration is also denied, you can file a formal appeal. The DME supplier or your doctor can help you with this step. The appeal process takes longer but gives you a chance to present your case to a Medicare reviewer who was not involved in the first decision.

Costs you will pay out of pocket

After Medicare approves the claim, you pay 20% of the Medicare-approved amount. The exact cost depends on what your supplier charges and what Medicare has set as the approved amount in your area — these vary by region.

If you have a Medigap or Medicare Advantage plan, your supplemental coverage may pay some or all of your 20% share. Call your plan before ordering to ask what your out-of-pocket cost will be.

You are also responsible for the full cost of any supplies or equipment ordered from a non-contracted supplier. If you order Purewick directly from the manufacturer or a retail supplier without going through a Medicare-contracted DME company, Medicare will not reimburse you.

Rental versus purchase

Most DME suppliers rent Purewick rather than sell it outright. Medicare covers rental as long as your doctor's order remains active. The rental typically includes the collection pouch, adhesive strips, and customer support.

If you rent for an extended period, some suppliers will eventually transfer ownership to you at no additional cost — this is called a rent-to-own arrangement. Ask your supplier whether they offer this option and what the timeline is.

If you want to purchase Purewick outright instead of renting, you can, but Medicare will only reimburse the rental portion. The purchase price is your responsibility. Some suppliers will credit rental payments toward a purchase if you decide to buy later.

What to ask your doctor

Before your appointment, write down these questions so you do not forget them:

  • Do you think Purewick is medically necessary for my condition?
  • Will you write an order for it, and will you explain in the order why it is necessary for me?
  • Do you have a preferred DME supplier, or should I find one on my own?
  • How long do you expect I will need to use Purewick?
  • If Medicare denies the claim, will you help me appeal or provide more information?

Frequently Asked Questions

Does Medicare Part D cover Purewick?

No. Part D covers prescription drugs only. Purewick is classified as durable medical equipment, which is covered under Part B. Do not ask your pharmacy to order it — you need a DME supplier.

What if I have a Medicare Advantage plan instead of Original Medicare?

Medicare Advantage plans must cover Purewick the same way Original Medicare does, but they may have different suppliers in your area or require prior approval from the plan before your doctor orders it. Call your plan's customer service number before seeing your doctor to ask about their process.

Can I use Purewick if I also have Medicaid?

If you have both Medicare and Medicaid (called dual coverage), Medicare is your primary payer. Medicaid may cover costs that Medicare does not, but you should contact your state Medicaid office to ask about their Purewick coverage rules, as they vary by state.

What if my doctor will not write an order for Purewick?

Ask your doctor to explain why they do not think it is appropriate for your condition. If you disagree, you can request a second opinion from another doctor, such as a urologist or geriatrician. Bring your medical records and explain your symptoms in detail to the second doctor.

Do I have to use the same supplier for the entire time I need Purewick?

No. You can switch suppliers at any time. If your current supplier is not meeting your needs, call Medicare or search the Supplier Directory again to find another contracted supplier in your area. Your new supplier can request your records from the old one.