Urological Supplies - JA DME
- Urinary Drainage Bags (230.17) National Coverage Determination (NCD)
- Urological Supplies Local Coverage Determination (LCD)
- Urological Supplies Policy Article
- 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
- 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|
|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|
|A4358||A4331, A5113, A5114|
|A5105||A4331, A4358, A5112, A5113, A5114|
|Continued Medical Need||
|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
Last Updated Tue, 11 Jul 2023 18:39:26 +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.