Most patients are eligible for reimbursement for all of the LoFric products, but coverage can vary by state and insurance plan.
Private insurance
Most private insurance companies cover the LoFric catheters, but coverage varies among plans. Please call us at 1-877-4-LOFRIC to ask about a specific plan.
Medicaid
Please contact Astra Tech or the patient's medical supplier to check on Medicaid coverage for LoFric in a specific state. In some cases, it may require you to also receive sterile insertion supplies.
For Medi-Cal beneficiaries in California, all LoFric catheters are available without sterile insertion supplies.
Medicare
Intermittent catheterization is covered when basic coverage criteria are met and the patient or caregiver can perform the procedure. For each episode of covered catheterization, Medicare will cover:
One catheter (A4351, A4352), up to 200 per month; or
One sterile intermittent catheter kit (A4353) if additional coverage criteria (see below) are met.
Medicare patients may obtain coverage for a LoFric Kit, if they meet at least one of the following criteria:
Patient has recurrent UTI, while on a program of sterile intermittent catheterization with A4351/A4352, twice within a 12-month period prior to the initiation of sterile intermittent catheter kits. The two infections must be at least 30 days apart if they are from the same pathogen. If the infections are within the same 30-day period, evidence must be submitted that they are not from the same pathogen.
Patient considered to have UTI if he/she has a urine culture > 10,000cfu of a urinary pathogen AND concurrent presence of one or more of the following signs, symptoms or lab findings
- Fever
- Complaints of urinary urgency, frequency or incontinence
- Systemic leukocytosis
- Pyuria (>5 wbc/hpf)
- Symptoms of autonomic dysreflexia (sweating, bradycardia, elevated B/P)
- Increased muscle spasms
Patient is immunosuppressed, for example (not all-inclusive):
- Taking immunosuppressive drugs post-transplant
- Taking chemotherapy for the treatment of cancer
- Has AIDS
- Taking oral corticosteroids
Patient has vesicoureteral reflux while on CIC
Pregnant patient on CIC due to a spinal cord injury
Patient resides in a nursing facility
A doctor’s order or prescription is required for patients to get intermittent catheter supplies and to begin the claims process. This would include the beneficiary’s name, detailed description of the item including brand name, approximate quantity used per month, start date of order, signature of treating physician, and date the order was signed.
Additional medical records which support permanent urinary incontinence or urinary retention or information supporting medical necessity for higher utilization than described may also be necessary.
Please contact us at 1-877-4-LOFRIC for further information or questions about insurance coverage for LoFric products.