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                              October 25, 2023

       Brian M. Bonnell
       Chief Financial Officer
       ICU Medical, Inc.
       951 Calle Amanecer
       San Clemente, CA 92673

                                                        Re: ICU Medical, Inc.
                                                            Form 10-K for the
fiscal year ended December 31, 2022
                                                            Form 10-Q for the
quarterly period ended June 30, 2023
                                                            Form 8-K dated
February 27, 2023
                                                            File No. 001-34634

       Dear Brian M. Bonnell:

              We have limited our review of your filings to the financial
statements and related
       disclosures and have the following comments.

              Please respond to this letter within ten business days by
providing the requested
       information or advise us as soon as possible when you will respond. If
you do not believe a
       comment applies to your facts and circumstances, please tell us why in
your response.

                                                        After reviewing your
response to this letter, we may have additional comments.

       Form 10-K for the fiscal year ended December 31, 2022

       Consolidated Financial Statements
       Note 1. Revenue Recognition, page 73

   1.                                                   We note you estimate
variable consideration related to rebates, chargebacks and product
                                                        returns. Please provide
in future filings the qualitative and quantitative information about
                                                        the significant
judgments and changes in judgments that significantly affect the
                                                        determination of your
transaction price, as set forth in ASC 606-10-50-1(b), 50-17(b), and
                                                        50-20(a). Please
provide us any intended revisions and the calculations used to determine
                                                        variable consideration
for the periods presented.
       Form 10-Q for the quarterly period ended June 30, 2023

       Liquidity and Capital Resources, page 49

   2.                                                   You set forth in your
disclosure "during the six months ended June 30, 2023, our cash and
 Brian M. Bonnell
ICU Medical, Inc.
October 25, 2023
Page 2
         cash equivalents and short-term investment securities increased by
$15.3 million from
         $213.0 million at December 31, 2022 to $197.7 million at June 30,
2023. This increase
         was primarily due to cash generated from operations." We note,
however, you
         experienced a decrease during that time frame. Please correct your
discussion in future
         filings.
3.       You disclose that "net income plus adjustments for non-cash net
expenses contributed
         $151.7 million." Please tell us whether you consider this reference a
non-GAAP measure
         and how you arrived at this determination. Please provide us any
intended revisions to
         your disclosure, as applicable. Refer to Item 10(e) of Regulation S-K.
Form 8-K dated February 27, 2023

Exhibit 99.1
Use of Non-GAAP Financial Information, page 6

4.       Please describe for us in further detail the "quality system and
product-related
         remediation" costs and the "quality and regulatory initiatives and
remediation" costs
         incurred during 2022 and 2023, and explain to us how you have
considered Non-GAAP
         Financial Measures Compliance & Disclosure Interpretations 100.01 as
part of making an
         adjustment for these costs in determining your non-GAAP measures.
       In closing, we remind you that the company and its management are
responsible for the
accuracy and adequacy of their disclosures, notwithstanding any review,
comments, action or
absence of action by the staff.

       Please contact Michael Fay at 202-551-3812 or Brian Cascio, Accounting
Branch Chief,
at 202-551-3676 with any questions.



                                                              Sincerely,
FirstName LastNameBrian M. Bonnell
                                                              Division of
Corporation Finance
Comapany NameICU Medical, Inc.
                                                              Office of
Industrial Applications and
October 25, 2023 Page 2                                       Services
FirstName LastName