Urinary Drainage Bags Form

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Urinary Drainage Bags

Notes: Coverage parameters for the single use urinary drainage bag are the same as those for the multi-use drainage bags.

Indications

(786820) Is the urinary drainage bag being used as a prosthetic device that replaces bladder function? 
(786821) Is the patient experiencing permanent urinary incontinence? 

Contraindications

(786822) Is the patient using the single use system bag for a non-permanent urinary incontinence condition? 
Effective Date

06/05/1997

Last Reviewed

NA

Original Document

  Reference



Background for this Policy

Urinary drainage bags that can be used either as bedside or leg drainage bags may be either multi-use or single use systems. Both the multi-use and the single use bags have a system that prevents urine backflow. However, the single use system is non-drainable.

Urinary collection and retention system are covered as prosthetic devices that replace bladder function in the case of permanent urinary incontinence.  There is insufficient evidence to support the medical necessity of a single use system bag rather than the multi-use bag. Therefore, a single use drainage system is subject to the same coverage parameters as the multi-use drainage bags.

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