|
|
|
Medicare Yesterday Per month Closed pouches Pastes and powders Only 1 supply at a time. Medicare Today Per Month Pastes and powders are available to help with adhesion and leakage Cohesive seals and strips help build a flat surface to keep skin dryer and avoid leakage. May receive 3 months supply at a time. |
Ostomy Update March 10,2005 Some of you have had your ostomy --
colostomy, ileostomy, urostomy --for many years. During those years
your ostomy may have changed, the manufacturers have developed new
products, and Medicare has changed. |
Changes in product type can be made without a prescription, but changes in quantity will require a new prescription from your doctor. |
|
New Products Clipless tail
closures |
||
|
Esteem Synergy Ostomy System Wafers and pouches attach with adhesive rather than flange seals |
Guidelines for Ordering Ostomy Supplies
The usual maximum number of pouches or wafers that Medicare determines to be medically necessary per month:
| Pouch drainable 1 and 2 piece | 20 per month |
| Pouch drainable w/extended wear barrier | no established limit per month |
| Pouch urinary 1 and 2 piece | 20 per month |
| Pouch urinary w/extended wear barrier | no established limit per month |
| Pouch closed | 60 per month |
| Wafer w/flange (standard wear) | 20 per month |
| Wafer w/flange w/extended wear barrier | no established limit per month |
| Skin barrier (standard) | 20 per month |
| Extended-wear barrier | no established limit per month |
| Barrier paste | 4 oz per month |
These are a guideline only and not necessarily the limit.
If Ostomate Needs Quantities Greater than
the Usual Maximum
-Need to provide supplier with information (documentation) explaining why
patient needs greater quantities.
-Describe the patient's condition, stoma, surrounding skin and other issues that
necessitate the increase.
-The medical necessity for use of a greater quantity of supplies that the amount
listed must be well documented in the patient's medical record and may be
requested by the DMERC.
Extended Wear Barrier Definition
An extended wear barrier is a pectin-based barrier with special additives which achieve a stronger adhesive seal, resist breakdown by urine or bowel effluent, permit longer wear time between changes, and normal wear times for those who cannot achieve them with standard barriers.
|
Supplies Per Ostomy |
| The following is
an excerpt from the Medicare Suppliers Manual:
"Ostomy supplies are covered for use on patients with a surgically created opening (stoma) to divert urine, feces or ileal contents outside the body. The quantity of ostomy supplies needed by a patient is determined to a great extent by the type of ostomy, its location, its construction, and the condition of the skin surface surrounding the stoma. There will be variation according to individual patient need. The table below (Elite will show one) lists the maximum number of items/units of service that are usually medically necessary. The actual quantity needed by a particular patient may be more or less than the amount listed….The medical necessity for use of a greater quantity of supplies than the amount listed must be well documented in the patient's records and may be requested by the DMERC. |
|