A pessary is a non-surgical, removable medical device inserted into the vagina to provide structural support for the pelvic organs, most commonly treating pelvic organ prolapse or stress urinary incontinence. Made from soft, medical-grade silicone, these devices act as an internal brace to relieve symptoms of heaviness, pressure, or involuntary urine leakage. Acquiring a pessary is not a simple retail transaction; it involves a medically guided process of diagnosis, sizing, and fitting to ensure effectiveness and patient safety. This professional pathway is necessary because the device must be precisely matched to the individual’s anatomy and medical condition.
Why Professional Assessment and Fitting are Required
You cannot simply buy a pessary off the shelf because it is a highly customized device that must be precisely fitted by a qualified healthcare provider. The goal of the fitting is to find the smallest possible size and the most appropriate shape that effectively manages symptoms without causing pain or discomfort. Pessaries come in numerous styles, such as the support-oriented Ring or the space-filling Cube and Gellhorn types, each intended to address different anatomical issues.
The fitting process is often conducted by a gynecologist, urogynecologist, or a specialized pelvic health physical therapist. It begins with a thorough pelvic examination to confirm the diagnosis and measure the dimensions of the vaginal canal and the degree of prolapse. This consultation involves trialing several different sizes and types from a fitting kit until the ideal device is found. The correct pessary must remain securely in place during activities like coughing or straining, yet should not be felt by the patient when correctly positioned.
Improper sizing or selection presents a risk of complications, which is why professional oversight is mandatory. A pessary that is too small may fall out, rendering the treatment ineffective. Conversely, a device that is too large can cause pain, vaginal wall erosion, or serious infections. The clinician confirms the fit and educates the patient on proper removal, cleaning, and reinsertion techniques, or establishes a schedule for regular in-office maintenance.
Navigating Official Procurement Channels
After the healthcare provider determines the correct size and type, acquiring the device follows different channels based on the provider and insurance plan. The most direct method is often dispensing the pessary directly from the clinician’s office, especially if they maintain a supply of common sizes. In this scenario, the cost of the device is often bundled with the initial fitting fee.
Alternatively, the patient receives a formal prescription for the specific device, which they take to a specialized supplier. Prescription pessaries are classified as Durable Medical Equipment (DME) rather than a standard prescription drug, meaning they are acquired through medical supply companies. These suppliers are distinct from retail pharmacies and handle the necessary documentation and billing for medical devices.
The prescription may be filled by a local medical supply store or through a mail-order DME provider. For billing purposes, the device is identified using specific Healthcare Common Procedure Coding System (HCPCS) codes, such as A4562 for non-rubber silicone pessaries. Some providers may have the patient purchase the device directly and bring it for final insertion, managing the device’s billing separately from the clinical service.
Cost, Insurance Coverage, and DME Status
The financial aspect of acquiring a pessary is determined largely by its classification as Durable Medical Equipment (DME). This classification means the device is subject to the coverage rules of the patient’s medical insurance plan, which differ from those governing prescription drugs. Coverage is provided if the device is medically necessary, but it requires the patient to meet their annual deductible and pay a co-insurance, often 20 percent of the Medicare-approved amount.
Patient cost includes the cost of the device and the fees for professional services. The device itself is relatively inexpensive, with wholesale costs ranging around $44 to $53 for a silicone type, though the retail price can be higher. The CPT code 57160 covers the initial fitting and insertion procedure, which may cost between $100 and $200 for those paying without insurance.
Most insurance plans require pre-authorization for DME to confirm medical necessity before the device is dispensed. Patients must also account for the cost of necessary follow-up appointments, which transition to a schedule of every three to twelve months for cleaning, inspection, and vaginal tissue assessment. These subsequent visits are billed as evaluation and management services and are subject to co-pays and deductibles.
Differentiating Prescription Pessaries from OTC Supports
It is important to distinguish the fitted, prescription-level pessary from similar-looking over-the-counter (OTC) internal supports. True prescription pessaries are designed primarily for the structural management of pelvic organ prolapse, such as when the bladder or uterus has descended. These devices, especially space-filling types like the Cube or Gellhorn, mechanically reposition the prolapsed tissue to relieve bulges and pressure.
In contrast, most OTC internal supports, such as Impressa or Uresta, are specifically designed to manage only stress urinary incontinence (SUI), which is leakage that occurs with physical strain. These non-prescription devices are sized differently and function by placing light pressure on the urethra through the vaginal wall, creating a supportive shelf. They do not possess the bulk or rigidity necessary to correct moderate to severe pelvic organ prolapse.
While OTC supports allow for self-selection and immediate purchase, they serve a limited, non-structural purpose. A prescription pessary requires professional fitting and offers a more robust, long-term solution for significant prolapse symptoms. Using an OTC device when a prescription fitting is needed may lead to insufficient symptom relief and delay appropriate treatment for the underlying structural issue.