Urological Supplies - JA DME
Urological Supplies
Coverage
- Urinary Drainage Bags (230.17) National Coverage Determination (NCD)
- Urological Supplies Local Coverage Determination (LCD)
- Urological Supplies Policy Article
Documentation
- Standard Documentation Requirements for All Claims Submitted to DME MACs
- Clinician Checklist Urological Supplies [PDF] - Checklist to assist clinicians with coverage and documentation requirements
- Clinician Letter - Intermittent Urinary Catheterization [PDF] - Letter may be sent to clinicians to assist in obtaining documentation
- Urological Supplies Documentation Checklist [PDF] - Checklist to ensure suppliers gather all required 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 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).
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 |