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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 state that intermittent catheterization is covered when basic coverage criteria are met and the 
beneficiary or caregiver can perform the procedure. 
 
For each episode of covered catheterization, Medicare will cover: 
 
    One catheter (A4351, A4352) and an individual packet of lubricant (A4332); or 
    One sterile intermittent catheter kit (A4353) if additional coverage criteria (see below) are met. 
 
Intermittent catheterization using a sterile intermittent catheter kit (A4353) is covered when the beneficiary 
requires catheterization and the beneficiary meets one of the following criteria (1-5): 
 
    The beneficiary resides in a nursing facility, 
    The beneficiary is immunosuppressed, for example (not all-inclusive): 
        on a regimen of immunosuppressive drugs post-transplant, 
        on cancer chemotherapy, 
        has AIDS, 
        has a drug-induced state such as chronic oral corticosteroid use. 
    The beneficiary has radiologically documented vesico-ureteral reflux while on a program of intermittent 
catheterization, 
    The beneficiary is a spinal cord injured female with neurogenic bladder who is pregnant (for duration of 
pregnancy only), 
    The beneficiary has had distinct, recurrent urinary tract infections, while on a program of sterile intermittent 
catheterization with A4351/A4352 and sterile lubricant A4332, twice within the 12-month prior to the initiation 
of sterile intermittent catheter kits. 
 
A beneficiary would be considered to have a urinary tract infection if they have a urine culture with greater 
than 10,000 colony forming units of a urinary pathogen AND concurrent presence of one or more of the 
following signs, symptoms or laboratory findings: 
 
    Fever (oral temperature greater than 38o C [100.4o F]) 
    Systemic leukocytosis 
    Change in urinary urgency, frequency, or incontinence 
    Appearance of new or increase in autonomic dysreflexia (sweating, bradycardia, blood pressure elevation) 
    Physical signs of prostatitis, epididymitis, orchitis 
    Increased muscle spasms 
    Pyuria (greater than 5 white blood cells [WBCs] per high-powered field) 
 
Refer to Coding Guidelines section of the related Policy Article for contents of the kit (A4353). A4353 should 
not be used for billing if the components are packaged separately rather than together as a kit. Separately 
provided components do not provide the equivalent degree of sterility achieved with an A4353. If separate 
components are provided instead of a kit (A4353) they will be denied as not reasonable and necessary. 
 
Use of a Coude (curved) tip catheter (A4352) in female beneficiaries is rarely reasonable and necessary. When 
a Coude tip catheter is used (either male or female beneficiaries), there must be documentation in the 
beneficiary's medical record of the medical necessity for that catheter. An example would be the inability to 
catheterize with a straight tip catheter. This documentation must be available upon request. If documentation is 
requested and does not substantiate medical necessity, claims will be denied as not reasonable and necessary. 
 
You can find this information in the Local Coverage Determination (LCD) Urological Supplies (L33803). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.