Coverage Criteria for Intermittent Urinary Catheters A4353 - Immunosuppressed Beneficiaries Meeting Criteria 2

Immunosuppressed criteria for the A4353 (intermittent urinary catheter, with insertion supplies) are covered when a beneficiary requires catheterization and the beneficiary is immunosuppressed, for example below (not an all-inclusive list).

  • On a regimen of immunosuppressive drugs post-transplant,
  • On cancer chemotherapy,
  • Has AIDS,
  • Has a drug-induced state such as chronic oral corticosteroid use.
  • High-level spinal cord injury patients (T3 and higher) will be considered for coverage when conducting medical reviews

Please note that the above list indicates that it is not an all-inclusive list. For all conditions, the practitioner is required to clearly document the condition causing the immunosuppression within the beneficiary’s medical records to qualify for criteria 2. These practitioner records must meet the medical necessity based on the coverage criteria listed within the Local Coverage Determination (LCD) L33803.

 

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