Incontinence is a common concern, affecting millions of seniors in the U.S. Many individuals rely on incontinence supplies such as absorbent pads and adult diapers to manage their condition. If you’re wondering about incontinence products-Medicare coverage, the answer depends on how you define “products.”
If you think of incontinence products as just disposable supplies like pads and diapers, then Medicare does not typically cover them. However, if you consider medical devices that help treat the underlying cause of incontinence to be incontinence products, then the good news is that Medicare does provide coverage for these solutions.
Medicare covers a variety of treatment devices, including at-home treatments like Elitone, which work to improve bladder control over time. This guide will help you understand Medicare’s policies on incontinence products, what’s covered, and how to get reimbursement for eligible treatments.
Does Medicare Cover Incontinence Products?
Medicare does not cover most incontinence supplies such as adult diapers, pads, and other absorbent products. These items are considered “personal convenience items” rather than medically necessary, which is why Medicare does not reimburse for them.
However, Medicare does cover medically necessary treatments that address incontinence at its source. This means that rather than paying out of pocket for disposable products, you may be eligible for coverage of medical devices and therapies that help improve bladder control, reducing or eliminating the need for supplies over time.
What Incontinence Treatments Does Medicare Cover?
Instead of covering disposable incontinence supplies like adult diapers or pads, Medicare focuses on treatments that address the root cause of incontinence. These options can significantly reduce or eliminate the need for incontinence products over time.
Pelvic Floor Therapy & Kegel Exercises
Medicare covers visits to a physical therapist for pelvic floor therapy, which helps patients learn how to properly perform pelvic floor exercises. This therapy is primarily effective for stress incontinence, which occurs when weak pelvic floor muscles cause urine leakage during activities like coughing, laughing, or exercising.
A trained therapist will guide patients through customized exercises, including Kegels, which involve contracting and relaxing the pelvic muscles. The goal of pelvic floor therapy is to teach patients how to correctly perform these exercises, which, when done consistently, can strengthen the pelvic muscles over time.
Medicare Part B covers a limited number of pelvic floor therapy sessions as part of outpatient physical therapy. However, before qualifying for more advanced treatments, patients are often required to demonstrate that they have attempted Kegels for at least four weeks without significant improvement.
Biofeedback Therapy
Biofeedback therapy is another Medicare-covered diagnostic tool that helps patients gain better control over their pelvic floor muscles. This technique typically involves the use of an internal vaginal probe, which provides real-time feedback about muscle activity. By seeing how their muscles respond on a monitor, patients can learn how to contract and relax them more effectively.
While biofeedback can improve bladder control and decrease urgency, it is primarily used as a diagnostic tool to assess muscle function rather than as a standalone treatment. Medicare Part B covers biofeedback therapy when provided by a qualified healthcare professional.
Electrical Stimulation Devices (Like Elitone)
Electrical stimulation therapy has been used for over 50 years as an effective method to help strengthen pelvic floor muscles and improve urinary incontinence symptoms. Traditionally, this therapy was almost exclusively provided with an internal vaginal probe or administered in a clinical setting by a healthcare professional. However, recent advancements have led to the development of FDA-cleared external electrical stimulation devices like Elitone, which offer a non-invasive, at-home treatment option.
Elitone is designed to deliver gentle electrical pulses externally, activating and strengthening the pelvic floor muscles without the need for an internal probe. This makes it an excellent choice for individuals who may feel uncomfortable with traditional internal treatments or those who prefer a convenient, at-home solution.
How to Get Medicare Coverage for Elitone
Medicare does cover Elitone, but patients must follow specific steps to qualify for coverage and receive reimbursement.
Step 1: Consult Your Doctor
Before Medicare will cover Elitone, you must first demonstrate that you have tried conservative treatments without success. Medicare requires patients to attempt a structured pelvic floor exercise plan for at least four weeks before moving on to advanced treatment options like Elitone.
✔ Schedule an appointment with your healthcare provider (urologist, gynecologist, or primary care physician) and discuss your symptoms and diagnosis (type of incontinence).
✔ Discuss the treatment options you have already tried, which should be documented.
✔ Your doctor will determine whether you qualify for Elitone based on the indication.
Step 2: Obtain a Prescription (Detailed Written Order – DWO)
Medicare requires a doctor’s prescription for Elitone before providing coverage. Your doctor will complete a Detailed Written Order (DWO), which will be submitted to Elitone or a Medicare-approved DME supplier.
✔ The prescription must include a statement of medical necessity.
✔ Your doctor must document your symptoms and previous treatments.
✔ The prescription must be sent to a Medicare-approved supplier.
Step 3: HCPCS Code for Insurance Coverage
When determining whether Elitone or similar at-home electrical stimulation devices are covered under your Medicare or private insurance plan, it’s important to ask about the HCPCS (Healthcare Common Procedure Coding System) code. This code also determines how it should be billed. In this case, this is a “Rental for 13 months,” after which you own it. This is true for all DME equipment over a certain dollar amount. The correct HCPCS code for electrical stimulation devices used for incontinence is:
E0745 – Neuromuscular Stimulator
Why is the HCPCS Code Important?
HCPCS codes are used by Medicare, Medicaid, and private insurers to categorize and approve medical devices for reimbursement. Without the proper code, an insurance provider may not recognize the device as eligible for coverage, leading to a denied claim. By specifically asking about HCPCS Code E0745, you increase your chances of getting clear information on whether your insurance will cover the cost of Elitone or similar devices.
How to Use the HCPCS Code When Inquiring About Coverage from non-traditional Medicare (or other private insurance)
By using the correct HCPCS code (E0745) and following the proper reimbursement steps, you can determine whether Elitone or other neuromuscular stimulators are covered under your insurance plan. If denied, you may still have options for out-of-pocket reimbursement or alternative payment plans.
Step 4: Claim Submission
Unlike traditional reimbursement claims, where patients submit forms directly to Medicare, Elitone or an approved DME supplier will handle the claim submission process.
Conclusion
If you’re searching for incontinence supplies covered by Medicare, remember that Medicare does not cover disposable products like adult diapers or pads. However, it does cover effective treatments like Elitone, pelvic floor therapy, and biofeedback therapy, which address the root cause of incontinence. Although there is a co-pay or deductible, this is usually less than the cost of pads.
By choosing treatment over temporary solutions, you can reduce dependency on incontinence products, improve bladder control, and enhance your overall quality of life. Talk to your healthcare provider today to explore Medicare-covered options for managing incontinence effectively.
For more details on Medicare reimbursement for incontinence treatments, visit Elitone’s reimbursement page.
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