CMS Pub. 100-02, ch. 7, § 40.1.2.7

A3-3118.1.B.7, HHA-205.1.B.7

Insertion and sterile irrigation and replacement of catheters, care of a suprapubic catheter,

and in selected patients, urethral catheters, are considered to be skilled nursing services.

Where the catheter is necessitated by a permanent or temporary loss of bladder control,

skilled nursing services that are provided at a frequency appropriate to the type of

catheter in use would be considered reasonable and necessary. Absent complications,

Foley catheters generally require skilled care once approximately every 30 days and

silicone catheters generally require skilled care once every 60-90 days and this frequency

of service would be considered reasonable and necessary. However, where there are

complications that require more frequent skilled care related to the catheter, such care

would, with adequate documentation, be covered.

EXAMPLE: A patient who has a Foley catheter due to loss of bladder control because

of multiple sclerosis has a history of frequent plugging of the catheter and urinary tract

infections. The physician has ordered skilled nursing visits once per month to change the

catheter, and has left a "PRN" order for up to three additional visits per month for skilled

observation and evaluation and/or catheter changes if the patient or caregiver reports

signs and symptoms of a urinary tract infection or a plugged catheter. During the

certification period, the patient's family contacts the HHA because the patient has an

elevated temperature, abdominal pain, and scant urine output. The nurse visits the patient

and determines that the catheter is plugged and there are symptoms of a urinary tract

infection. The nurse changes the catheter and contacts the physician to report findings

and discuss treatment. The skilled nursing visit to change the catheter and to evaluate the

patient would be reasonable and necessary to the treatment of the illness or injury. The

need for the skilled services must be documented.