Urological Supplies - JD DME

Urological Supplies

Coverage

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 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.

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 Wed, 12 Oct 2022 16:57:09 +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.

Determining the Maximum Quantity of Urological Supplies 01/04/2023

Continued Medical Need - Urological and Ostomy Supplies 08/09/2022

Urological Supplies and Continued Medical Need 05/16/2022

Irrigation Supply Sleeves - Correct Coding 02/10/2022

Service Specific Post-Payment Reviews 01/14/2022

Service Specific Post-Payment Reviews 10/20/2021

LCD and Policy Article Revisions Summary for April 29, 2021 04/29/2021

Service Specific Post-Payment Review: December 2020 - February 2021 03/30/2021

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Urological Supplies - JD DME

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