What is included in A4353?

The insertion kit (A4353) contains a catheter (may be packaged separately from the other components), lubricant, gloves, antiseptic solution, applicators, a drape, and a collection tray/bag in a sterile package intended for single use.

What is procedure code A4351?

Long Description for A4351: INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH.

Do you need a prescription for a catheter?

Yes, all urinary catheters require a prescription, regardless of the supplier you choose. Each catheter package has a symbol on it that indicates these products are an “RX only” (i.e. prescription only) item.

Why is PureWick not covered by Medicare?

POLICY HMO, PPO, Individual Marketplace, Elite/ProMedica Medicare Plan The PureWick urine collection system is unproven and not medically necessary for the management of urinary incontinence. Therefore, procedure K1006 is not covered.

Does insurance cover external catheter?

Medicare covers external catheters/urinary collection devices (female or male) as an alternative to an indwelling catheter for patients who have permanent urinary incontinence.

Are catheter supplies covered by Medicare?

Yes! Medicare covers catheter supplies when medically necessary. You may be eligible to receive enough catheters for one-time sterile-use catheterization, which is based on your unique needs and amount of times you have to catheterize per day.

Are intermittent catheters considered durable medical equipment?

Medicare Part B covers outpatient care, home healthcare, doctor’s services, and durable medical equipment—intermittent catheters are considered durable medical equipment.

How many catheters Will Medicare pay for?

200 catheters
Medicare will allow for the usual maximum of 200 catheters per month or one catheter for each episode of catheterization. Other payers allowed catheters per month may differ from Medicare’s, so it is important for you to check with your insurance plan to see how many catheters your plan allows.

Does Medicare cover catheter changes?

How much does a catheter cost?

Depending on the type, intermittent catheters cost between $1 and $3. Patients may also need to buy packets of lubrication separately. So a year’s supply of catheters alone could cost as much as $4,400. But even patients who reuse catheters need several new ones per month.

How many catheters Will Medicare pay for per month?

200
Broadly, Medicare covers 200 intermittent single-use catheters each month (straight tip or coudé-tip). This also includes “closed-system” catheters, or catheters with sterile insertion supplies.

What does a4351 stand for?

A4351: INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH A4352: INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMERIC, OR HYDROPHILIC, ETC.), EACH

Is lubricant separately payable for HCPCS code a4353?

Sterile lubricant is not separately payable when the supplier bills for HCPCS code A4353. Payment for the lubricant is included in the fee schedule for the kit.

How often are a4333 and a4334 denied?

More than 3 per week of A4333 or 1 per month of A4334 will be denied as not reasonable and necessary. A catheter/tube anchoring device (A5200) is covered and separately payable when it is used to anchor a covered suprapubic tube or nephrostomy tube.

Can a female beneficiary use a Coude tip catheter (a4352)?

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.