Our health plan will not reimburse components of the intermittent catheterization kits separately when utilized during the same episode of catheterization.
An intermittent urinary catheter with insertion supplies (HCPCS A4297, A4353) is a kit, which includes a catheter and all supplies necessary for single, sterile insertions. HCPCS A4297 or A4353 may be used if any of the following are met:
- A single sterile package containing both an intermittent urinary catheter and all necessary insertion/collection supplies; or
- A sterile intermittent urinary catheter plus a separately packaged sterile kit containing insertion/collection supplies; or
- A sterile “no-touch” type of catheter system
The insertion kit (HCPCS A4297, A4353) described in bullets 1 & 2 above contain an intermittent urinary catheter (packaged separately from the other components in bullet 2), lubricant, gloves, antiseptic solution, applicators, a drape, and a collection tray/bag in a sterile package intended for single use. The collection tray/bag is a separate item included within the kit; therefore, materials that serve as non-sterile packaging to contain all the items in the kit do not meet this requirement. Except as noted in bullet 2 above, HCPCS A4297 or A4353 must not be billed if individual insertion kit components are provided as separate items. When providing a sterile kit, all components are included and packaged as a kit. Separate billing of individual components is considered unbundling.
The product described in bullet 3 is a single-catheter system that is functionally equivalent to a complete sterile insertion kit (HCPCS A4297, A4353) containing a catheter and the additional components as described in the previous paragraph. To be coded as HCPCS A4297 or A4353, a “no-touch” type of catheter system must be a sterile, all-inclusive, self-contained system capable of accomplishing intermittent catheterization with sterile technique without the use of additional supplies such as gloves, lubricants, collection chamber, etc. Additional individual components must not be billed separately. Separate billing of additional supply items is considered unbundling.
References
Cross References
Adm 105 – Bundling Edits
Adm 129 – Correct Coding Guidelines
