Retired - Urological Supplies – A4353 Correct Coding Clarification Policy Revision

The Coding Guidelines section of the Urological Supplies Policy Article has been revised to clarify the correct coding for use of HCPCS code A4353 (Urinary intermittent catheter with insertion supplies).  The revised passage states:

A urinary intermittent catheter with insertion supplies (A4353) is a kit which includes a catheter and all supplies necessary for sterile insertion (see below).  Code A4353 may be used if either 1 or 2 is supplied:

1. A sterile intermittent urinary catheter plus a separately packaged sterile kit of insertion/collection supplies; or,
2. A single sterile package containing both a catheter and all insertion/collection supplies.

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.  The collection tray/bag is a separate item included as part of the kit; therefore, materials that serve as non-sterile packaging to contain all of the items in the kit do not meet this requirement.  Except as noted in 1 above, code A4353 must not be billed if individual insertion kit components are provided as separate items.  When providing a sterile kit, the individual components must not be separately billed.

Suppliers are reminded that payment for code A4353 includes both the catheter and all insertion supplies.  Separate billing for the catheter and/or any insertion supplies is incorrect.

The Local Coverage Determination (LCD) section on Intermittent Catheterization also has been revised to be consistent with the Coding Guideline above.  The revised material in the LCD states:

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.

Refer to the LCD, Policy Article, and Supplier Manual for additional information.

For questions about correct coding contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form located on the PDAC website: https://www.dmepdac.com.