How to Get PureWick Covered by Insurance: Authorization Guide

Is PureWick covered by insurance? In most cases yes, but coverage is never automatic. PureWick insurance coverage depends on three things being true at once: a physician documents medical necessity, the right paperwork is filed, and the system comes from an accredited durable medical equipment (DME) supplier.

That last condition is the one that catches people out. A system bought from an online marketplace or a retail pharmacy is not reimbursed by any plan, however well the patient qualifies. This guide covers what each type of plan requires, the codes your doctor’s office will ask for, and why authorizations get delayed.

Which plans cover PureWick?

The short version, before the detail:

Plan type	Covers PureWick?	What it usually requires
Medicare Part B	Yes, as durable medical equipment	Physician order, documented incontinence diagnosis, accredited supplier
Medicare Advantage (Part C)	Usually, but criteria are set by the plan	Same documentation, plus the plan’s own prior authorization rules
Medicaid	Varies by state and by managed care organization	State-specific prior authorization, often stricter quantity limits
Private and employer plans	Most major plans, under the DME benefit	Prior authorization, sometimes a quantity cap per month

RA Fischer Co. verifies any of these at no cost and with no obligation, before a single form is signed. That verification step is worth doing first, because it prevents the most common and most expensive mistake: completing a full authorization packet for a plan that was never going to cover the device.

Already have a PureWick from another supplier? You do not need to have bought your system from us to get refill coverage through us. If your plan covers the supplies, we can take over the monthly refills — see the Medicare coverage page for how that works.

One note on who the system is for. RA Fischer carries the PureWick Female External Catheter system only. If you are looking for a male external catheter, this particular system is not the right fit, and we would rather tell you that now than after the paperwork.

Does Medicaid cover PureWick?

Often, but Medicaid is the least uniform of the three. Coverage rules are set state by state, and if you are enrolled in a Medicaid managed care organization rather than straight fee-for-service Medicaid, that organization sets its own prior authorization criteria on top of the state’s.

In practice this means two things. The documentation bar is usually the same as Medicare’s — a physician order, a documented incontinence diagnosis, and home use — but the approval process often takes longer. And quantity limits are more common, so the number of wicks approved per month may be lower than Medicare’s standard allowance.

If you are dual-eligible, meaning you have both Medicare and Medicaid, Medicare is billed first and Medicaid may cover part or all of the remaining patient responsibility. We check both when we verify.

Is PureWick covered by Medicare?

Yes, for eligible patients. Medicare Part B covers the PureWick system as durable medical equipment for home use, along with monthly wick refills, when it is supplied by a Medicare-accredited provider.

Medicare is the most common pathway and has its own page covering eligibility, exactly what you pay, the step-by-step process and the authorization form download: Does Medicare cover PureWick?

Does PureWick require a prescription?

Yes. Every plan that covers it requires a PureWick prescription — a physician order — and no insurer will reimburse the system without one. The order needs to specify the PureWick Female External Catheter system for home use, supported by chart notes documenting urinary incontinence.

You can buy a PureWick system privately without a prescription, but doing so forfeits coverage entirely — the claim cannot be submitted retroactively. If there is any chance your plan will pay, get the order first.

You do not need to obtain it yourself. Once we have verified your plan, we send the authorization packet directly to your doctor’s office and follow up with them until it comes back complete.

PureWick CPT code, HCPCS A4328 and ICD-10

If you are calling your insurer, or your doctor’s billing office is checking benefits, these are the codes they will want. People commonly search for a PureWick CPT code, but for supplies like this the relevant system is HCPCS rather than CPT — CPT codes describe procedures, not equipment.

• HCPCS A4328 — female external urinary collection device. This is the supply code to quote when asking whether external catheter systems are covered and whether prior authorization is required.
• ICD-10 diagnosis codes — the most commonly approved are R33.9, R32, N39.46 and N39.498. Your physician selects the one matching the documented diagnosis.

When you call member services, the most useful question is specific: “Is HCPCS A4328 covered under my DME benefit, and does it require prior authorization?” That phrasing gets a straight answer far more often than asking about PureWick by brand name, which front-line representatives frequently do not recognise.

What your doctor needs to provide

Your physician does not need to draft anything from scratch. Our three-page authorization packet arrives at their office pre-formatted and contains everything the insurer requires. They complete and sign it.

• The written order for the PureWick Female External Catheter system and supplies
• Quantities and schedule needed for authorization
• The approved ICD-10 diagnosis code
• A Letter of Medical Necessity, structured and pre-formatted
• Chart notes documenting urinary incontinence

We send the packet, then follow up with the office until every field is complete. That follow-up is not administrative politeness — incomplete paperwork is the single most common cause of delay, and catching it before submission rather than after a denial regularly saves patients weeks.

Why authorizations get denied, and what to do

Most denials are fixable, and most are procedural rather than a judgement that the patient does not qualify. Two causes account for the majority:

• Documentation that does not meet the plan’s definition of medical necessity. Usually a chart note describing the symptom without establishing the diagnosis, or a missing diagnosis code.
• No recent face-to-face encounter. Most plans require a qualifying physician visit documented within the previous six months. A patient who has not seen their doctor in a year can be denied on that basis alone, regardless of how clear the clinical need is.

You have the right to appeal, and appeals must be filed within the window stated on the denial notice. If an authorization has been denied — whether or not the original order came through us — contact us and we will identify the reason and help with the appeal.

Quantity limits and what they cost you

On a private or Medicaid plan, ask about quantity limits specifically. Many insurers cap external catheter supplies per month, and anything beyond the cap is billed at full price. This is the cost surprise patients hit most often, and it is entirely avoidable if the cap is known up front.

We can set up automatic shipments timed to your plan’s approved schedule, which keeps supply continuous and costs predictable. For Medicare cost-sharing specifically — the deductible, the 20% coinsurance and how Medigap affects it — see the Medicare coverage page.

Frequently asked questions

Check your coverage

RA Fischer Co. has supplied durable medical equipment since 1948 and handles PureWick authorizations as routine work. We verify your plan, send the packet to your doctor’s office, chase it until it is complete, and submit to the insurer on your behalf.

Start a free coverage check or call (800) 525-3467. No obligation either way.