Insurance Coverage for LoFric Products

Most patients are eligible for reimbursement for at least one of the LoFric products. Coverage varies by state and by insurance plan.

Coverage for Medicaid Patients
The LoFric Ready-Kit is covered by Medicaid in numerous states. Please contact Astra Tech or the patient's homecare dealer to check on Medicaid coverage in a specific state.

The LoFric catheter is covered by Medicaid in the states of California, Texas, and for certain Medicaid patients in the state of Michigan.

The LoFric Cath-Kit is covered by Medicaid in the state of California.

Coverage for Medicare patients

Medicare guidelines are as follows:

• Medicare patients may obtain coverage for hydrophilic catheters together with sterile insertion supplies under Medicare code A4353 if they meet at least one of the following criteria designating that they require sterile catheterization.
  
  To obtain a hydrophilic catheter together with sterile insertion supplies, the patient may order our LoFric Ready-Kit. Some homecare dealers may prefer to provide a Medicare patient with the LoFric catheter together with the dealer's own sterile supplies kit.
  
  STERILE CATHETERIZATION CRITERIA:
  
• Patient has recurrent UTIs, while on CIC, twice within a 12-month period prior to beginning sterile intermittent catheterization. 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.
  
  A patient is considered to have a UTI if he or 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
  
  OR
  
  Patient is immunosuppressed, for example:
  
• Taking immunosuppressive drugs post-transplant
  
• Taking chemotherapy for the treatment of cancer
  
• Has AIDS
  
• Taking oral corticosteroids
  
  OR
  
  Patient has vesicoureteral reflux while on CIC
  
  OR
  
  Patient is pregnant and on CIC due to a spinal cord injury
  
  OR
  
  
• Patient resides in a nursing facility
  
  Medical necessity for use of sterile catheterization for reasons other than the criteria listed may be presented for individual consideration. Click on the link at the bottom of the page to go to the Medicare Appeals and Grievances section.
  
  The patient must state, when asked, that it is acceptable to them to receive the sterile insertion supplies along with the catheter.
  
  A patient who qualifies under any of the criteria above may also get coverage for the LoFric Tiemann (coudé tip) catheter, without sterile supplies, if the patient is also unable to pass a straight tip catheter. Documentation by the physician that a coudé tip catheter is medically necessary (for example, that the patient cannot pass a straight tip catheter) must be present in the patient’s records.
  

Coverage under Private Insurance Plans
Coverage for LoFric products varies among private insurance plans. Please call us at 1-877-4-LOFRIC to ask about a specific plan.

Please contact us at 1-877-4-LOFRIC for further information or questions about insurance coverage for LoFric products.