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Urological Supplies - JA DME

Urological Supplies




  • Medical Review - View notifications/findings of pre/post claim reviews completed by Noridian Medical Review


Per the bundling table listed in Policy Article A52521:

  • When the bundled code listed in Column I is billed, the codes in column II are not separately payable.
  • When the codes in Column II are provided at the same time, it must be billed with the bundled code listed in Column I.
Column I Column II
A4310 A4332
A4311 A4310, A4332, A4338
A4312 A4310, A4332, A4344
A4313 A4310, A4332, A4346
A4314 A4310, A4311, A4331, A4332, A4338, A4354, A4357
A4315 A4310, A4312, A4331, A4332, A4344, A4354, A4357
A4316 A4310, A4313, A4331, A4332, A4346, A4354, A4357
A4354 A4310, A4331, A4332, A4357
A4357 A4331
A4358 A4331, A5113, A5114
A5105 A4331, A4358, A5112, A5113, A5114
A5112 A5513, A5114



Topic Details
Continued Medical Need
  • For all DMEPOS items, the initial justification for medical need is established at the time the item(s) is first ordered, therefore, beneficiary medical records demonstrating that the item is reasonable and necessary are created just prior to, or at the time of, the creation of the initial prescription. Once initial medical need is established, ongoing need for urological supplies is assumed to be met. There is no requirement for further documentation of continued medical need if the beneficiary continues to meet the Prosthetic Devices benefit.
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


Last Updated Wed, 08 Nov 2023 20:06:26 +0000

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