2025 HCPCS code A4351
(Active) Effective Date: N/A Revision Date: N/A Medical Supplies - Incontinence Devices and Supplies Medical And Surgical Supplies Feed
Intermittent urinary catheter; straight tip, with or without coating (Teflon, silicone, silicone elastomer, or hydrophilic).
Modifiers may apply depending on the circumstances of service, such as the place of service or the type of catheter used.Consult payer guidelines for specifics.
Medical necessity is established by the presence of a condition requiring intermittent catheterization, such as urinary retention, incontinence, or neurogenic bladder. Documentation must support the need for this intervention and demonstrate that alternative, less invasive methods have been considered or are ineffective. The frequency and type of catheter must be medically appropriate for the patient's condition.
The provider's clinical responsibility includes selecting the appropriate catheter type and size, performing the intermittent catheterization procedure, and ensuring proper aseptic technique to prevent infection.They should also educate the patient or caregiver on proper catheterization techniques and hygiene.
In simple words: This code is for a single, straight tube used to drain urine from the bladder.The tube is inserted and removed each time it's needed and can have a special coating to make it easier to use.
This HCPCS code, A4351, represents the provision of a single straight-tip urinary catheter used for intermittent catheterization.The catheter may be coated or uncoated with materials such as Teflon, silicone, silicone elastomer, or hydrophilic substances.Intermittent catheterization involves the periodic insertion and removal of a catheter to drain urine, as opposed to indwelling catheters that remain in place.
Example 1: A patient with spinal cord injury and neurogenic bladder requires intermittent catheterization at home. The provider uses code A4351 for each straight-tip catheter utilized., A patient with urinary retention due to benign prostatic hyperplasia (BPH) undergoes intermittent catheterization in a physician's office. Code A4351 is reported for each catheter used., A patient with multiple sclerosis experiences intermittent urinary incontinence and is taught self-catheterization. Code A4351 is used for each catheter used during training and subsequent home use.
A physician's order specifying the need for intermittent catheterization. Documentation indicating the diagnosis necessitating the catheterization (e.g., neurogenic bladder, BPH, multiple sclerosis). Documentation of the catheterization procedure including date, time, and the type of catheter used.Patient's age, gender, and any relevant allergies or medical history.
** Medicare coverage requires specific documentation to support medical necessity, including diagnoses and the ineffectiveness of less invasive options.The type and frequency of catheters must be clinically appropriate and meet all Medicare guidelines.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Urology, Neurology, Geriatrics, Family Medicine
- Place of Service:Office, Home, Skilled Nursing Facility, Hospital (Inpatient or Outpatient), Assisted Living Facility