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Urological Supplies

Coverage

Documentation

Reviews/Audits

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

Bundling

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

 

Tips

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 ostomy 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.

 

Last Updated Thu, 19 May 2022 14:59:57 +0000

The below are topic specific articles which have been published to "Latest Updates" and sent out in Noridian emails within the past two years. Exclusions to this include time sensitive related announcements such as: Noridian and CMS educational events, Ask-the-Contractor Teleconferences and claims processing downtime.

paginationType noridian
Urological Supplies Webinar - September 29, 2022 08/30/2022
Continued Medical Need - Urological and Ostomy Supplies 08/09/2022
Targeted Probe and Education (TPE) Pre-Payment Reviews 07/27/2022
Urological Supplies and Continued Medical Need 05/16/2022
Irrigation Supply Sleeves - Correct Coding 02/10/2022
Service Specific Post-Payment Review: March 2021 - May 2021 06/30/2021
LCD and Policy Article Revisions Summary for April 29, 2021 04/29/2021
Service Specific Post-Payment Review: December 2020 - February 2021 04/12/2021
LCD and Policy Article Revisions Summary for October 15, 2020 10/15/2020
Urological Supplies (HCPCS A4351 & A4352) Notification of Service Specific Post-Payment Review 09/28/2020