Intermittent Catheter Supplies

Policy No: 149
Date of Origin: 03/01/2024
Section: Administrative
Last Reviewed:
Last Revised:
Approved: 11/09/2023
Effective: 03/01/2024
Policy Applies To: Group and Individual & Medicare Advantage

This policy applies only to physicians and other qualified health care professionals, including Durable Medical Equipment (DME) providers.

Intermittent Catheterization – Intermittent catheterization is the use of catheters to drain urine from the bladder at intervals throughout the day.

Sterile Intermittent Catheterization Kits – Sterile intermittent catheterization kits include an intermittent urinary catheter, applicator, a drape, and a collection tray/bag in a sterile package.

This policy applies only to the supplies/accessories used for intermittent catheterization.

Supplies/accessories used for intermittent catheterization may be covered up to the maximum quantities and frequencies as outlined in the Centers for Medicare & Medicaid Services (CMS) Local Coverage Determinations (LCD).

When the total units of service for a Healthcare Common Procedure Coding System (HCPCS) code have exceeded the maximum allowed within the specified time frame, our health plan will allow up to that limit and deny the remaining units. Our health plan will allow up to a 10-day grace period.

Our health plan will not reimburse components of the intermittent catheterization kits separately when utilized during the same episode of catheterization.

An intermittent urinary catheter with insertion supplies (HCPCS A4353) is a kit, which includes a catheter and all supplies necessary for single, sterile insertions. HCPCS A4353 may be used if any of the following are met:

• A single sterile package containing both an intermittent urinary catheter and all necessary insertion/collection supplies; or
• A sterile intermittent urinary catheter plus a separately packaged sterile kit containing insertion/collection supplies; or
• A sterile "no-touch" type of catheter system

The insertion kit (HCPCS A4353) described in bullets 1 & 2 above contain an intermittent urinary catheter (packaged separately from the other components in bullet 2), 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 within the kit; therefore, materials that serve as non-sterile packaging to contain all the items in the kit do not meet this requirement. Except as noted in bullet 2 above, HCPCS A4353 must not be billed if individual insertion kit components are provided as separate items. When providing a sterile kit, all components are included and packaged as a kit. Separate billing of individual component is considered unbundling.

The product described in bullet 3 is a single-catheter system that is functionally equivalent to a complete sterile insertion kit (HCPCS A4353) containing a catheter and the additional components as described in the previous paragraph. To be coded as HCPCS A4353, a "no-touch" type of catheter system must be a sterile, all-inclusive, self-contained system capable of accomplishing intermittent catheterization with sterile technique without the use of additional supplies such as gloves, lubricants, collection chamber, etc. Additional individual components must not be billed separately. Separate billing of additional supply items is considered unbundling.

Center for Medicare & Medicaid Services (CMS) LCD - Urological Supplies (L33803) (cms.gov)

Center for Medicare & Medicaid Services (CMS) Article - Urological Supplies - Policy Article (A52521) (cms.gov)

Bundling Edits
Correct Coding Guidelines