Urethral Inserts (A4336)—Coverage and Documentation (A50231)

Urethral inserts (A4336) are covered for adult females with stress incontinence when basic coverage criteria are met and the patient or caregiver can perform the procedure. They are not indicated for women:

• with bladder or other urinary tract infections (UTI);
• with a history of urethral stricture, bladder augmentation, pelvic radiation or other conditions where urethral catheterization is not clinically advisable;
• who are immunocompromised, at significant risk from UTI, interstitial cystitis,  or pyleonephritis, or who have severely compromised urinary mucosa;
• unable to tolerate antibiotic therapy;
• on anticoagulants;
• with overflow incontinence or neurogenic bladder.

If requested, the medical record must contain information that substantiates the need for this item and shows that none of the above listed contraindications are present.

This coverage expansion will be incorporated into the next revision of the Urological Supplies LCD.

Refer to the LCD and Policy Article for Urological Supplies for additional information.