Does Medicare Cover Incontinence Surgery

If you're having trouble controlling the flow of your urine or the release of your stool, you may have incontinence. Incontinence can range in severity from mild to severe, depending on the type of incontinence and the cause.

Urinary incontinence is involuntary leakage of urine from the bladder. Fecal incontinence is the inability to control the passage of gas or stool. Treatments for incontinence can include exercises, lifestyle modifications, and medications. Surgery also can be an option. If you're wondering if Medicare covers incontinence surgery, read on for more details.

Does Medicare cover incontinence surgery?

Medicare may cover your incontinence surgery if you meet certain requirements. Original Medicare and Medicare Advantage plans cover certain incontinence surgeries and procedures that involve implantable devices when they are deemed medically necessary.

Original Medicare covers inpatient surgeries under Part A and outpatient procedures under Part B.

Types of incontinence surgery covered by Medicare

Below are examples of the types of surgeries and procedures that involve implantable devices that may be covered by original Medicare or Medicare Advantage:

• Artificial urinary sphincter (AUS) implantation: An AUS replaces the urinary sphincter to control urine flow from the bladder. Typically, an AUS device and its implantation are covered when they're deemed medically necessary.

• Bladder sling surgery: Also known as a bladder lift, this incontinence surgery is a minimally invasive procedure that supports the urethra and helps it stay closed when not urinating. There are different procedures for people with male anatomy and female anatomy.

• Sacral nerve stimulation:This procedure is covered for the treatment of urinary retention, urinary urge incontinence, and urgency-frequency syndrome. Medicare coverage also includes a temporary test stimulation to determine the potential effectiveness of an implant as well as the procedure to place a permanent stimulator.

• Transurethral radiofrequency micro-remodeling: Covered by Medicare for the treatment of urinary stress incontinence in women, this procedure uses radio frequency energy to shrink and stabilize tissue in the body to support the urethra and bladder neck.

• Urethroplasty: This procedure repairs a defect or injury in the walls of the urethra.

This is not an exhaustive list. Original Medicare or Medicare Advantage may cover other surgical procedures and implantable devices if they're deemed medically necessary for treating incontinence.

How to get your surgery covered by Medicare

Medicare coverage for a urinary incontinence surgery depends on the type of procedure and your diagnosis. For your procedure to be covered, you will need to work with your healthcare professional to determine the cause of your incontinence and that a specific surgery is a medically necessary solution.

Your healthcare professional may order tests to help diagnose your incontinence. And before considering surgery, they may recommend nonsurgical options for managing your symptoms, such as:

• Bladder training

• Botox (onabotulinumtoxinA), which can be used to treat overactive bladder (OAB)

• Pelvic floor exercises (also known as kegels)

• Prescription medications

• Weight loss

If these treatment options are not successful, your healthcare professional may determine that urinary incontinence surgery is medically necessary.

Will Medicare cover other incontinence treatments and supplies?

Medicare covers certain incontinence treatments and urological devices when they're considered medically necessary.

Absorbent supplies

Original Medicare does not cover absorbent incontinence supplies, such as adult diapers, for any condition. These items are not considered medical equipment, but rather disposable personal hygiene products. Some Medicare Advantage plans may cover these incontinence supplies as an over-the-counter (OTC) benefit.

If you have Medicaid - or Medicaid with Medicare because of dual eligibility - your absorbent incontinence supplies may be covered. Most Medicaid programs cover medically necessary absorbent incontinence products, though they're not required to offer this benefit.

Medications

Medications can help if your urinary incontinence is a symptom of OAB. Common prescription medications used to treat OAB - which would be covered by Medicare Part D - include:

• Myrbetriq (mirabegron)

• Gemtesa (vibegron)

• Gelnique (oxybutynin)

In addition, Medicare Part B covers incontinence medications, such as Botox, that must be administered by a healthcare professional.

If you have original Medicare, you must buy a standalone Part D plan. Part D is included with most Medicare Advantage plans, but if it's not, you'll need to buy a separate plan to get coverage for your medications.

Urological devices

Medicare Part B or Medicare Advantage may offer coverage for nonabsorbent urological devices and supplies as durable medical equipment. To get coverage, you'll need a diagnosis of permanent urinary incontinence or permanent urinary retention.

Urological devices that may be covered by Medicare include:

• Condom catheters

• Indwelling catheters

• External urinary collection devices

If you have one of the devices listed above, some associated supplies also may be covered.

To get coverage for these devices and supplies, you'll need to order them through a Medicare-approved supplier and have a prescription from your healthcare professional.