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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that urinary catheters and external urinary collection devices are covered to drain or collect urine 
for a beneficiary who has permanent urinary incontinence or permanent urinary retention. Permanent urinary 
retention is defined as retention that is not expected to be medically or surgically corrected in that beneficiary 
within 3 months. If the catheter or the external urinary collection device meets the coverage criteria, then the 
related supplies that are necessary for their effective use are also covered. Urological supplies that are used for 
purposes not related to the covered use of catheters or external urinary collection devices (i.e., drainage and/or 
collection of urine from the bladder) will be denied as non-covered. The beneficiary must have a permanent 
impairment of urination. This does not require a determination that there is no possibility that the beneficiary's 
condition may improve sometime in the future. If the medical record, including the judgment of the treating 
practitioner, indicates the condition is of long and indefinite duration (ordinarily at least 3 months), the test of 
permanence is considered met. Catheters and related supplies will be denied as non-covered in situations in 
which it is expected that the condition will be temporary. 
 
The use of a urological supply for the treatment of chronic urinary tract infection or other bladder condition in 
the absence of permanent urinary incontinence or retention is non-covered. Since the beneficiary's urinary 
system is functioning, the criteria for coverage under the prosthetic benefit provision are not met. 
 
Other supplies used in the management of incontinence, including but not limited to the following items, will 
be denied as non-covered because they are not prosthetic devices, nor are they required for the effective use of 
a prosthetic device: 
 
    1. Creams, salves, lotions, barriers (liquid, spray, wipes, powder, paste) or other skin care products (A6250) 
    2. Catheter care kits (A9270) 
    3. Adhesive remover (A4455, A4456) (Coverage remains for use with ostomy supplies.) 
    4. Catheter clamp or plug (A9270) 
    5. Non-Disposable underpads (A4553) 
    6. Disposable underpads, e.g., Chux (A4554) 
    7. Diapers, or incontinent garments, disposable or reusable (A4520) 
    8. Drainage bag holder or stand (A9270) 
    9. Urinary suspensory without leg bag (A9270) 
    10. Measuring container (A9270) 
    11. Urinary drainage tray (A9270) 
    12. Gauze pads (A6216, A6217, A6218) and other dressings (coverage remains under other benefits, e.g. surgical dressings) 
    13. Other incontinence products not directly related to the use of a covered urinary catheter or external 
urinary collection device (A9270) 
    14. Disposable external urethral clamp or compression device, with pad and/or pouch, (A4360) 
 
The general term "external urinary collection devices" used in this policy includes male external catheters and 
female pouches or meatal cups. This term does not include diapers or other types of absorptive pads. A meatal 
cup female external urinary collection device (A4327) is a plastic cup, which is held in place around the female 
urethra by suction or pressure and is connected to a urinary drainage container such as a bag or bottle. A pouch 
type female external collection device (A4328) is a plastic pouch which is attached to the periurethral area with 
adhesive, and which can be connected to a urinary drainage container such as a bag or bottle. You can find 
these rules in the Local Coverage Article Urological Supplies - Policy Article A52521. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.