## **What is HCPCS code A4353?**
HCPCS code A4353, which has a code description "intermittent urinary catheter with insertion supplies," refers to a sterile intermittent urinary catheter plus a separately packaged sterile kit of collection supplies or a sterile intermittent urinary catheter kit which includes the catheter and all necessary insertion supplies for a single, sterile insertion.
To elaborate, a single sterile package includes items such as lubricant, gloves, antiseptic wipes, and underpads, facilitating a sterile and self-contained catheterization process.
Do note that this kit is often referred to as a "closed system" or "no-touch" catheter kit that's able to accomplish intermittent catheterization without the need for additional supplies.
A4353 is intended for patients requiring routine intermittent catheterization due to urinary retention, neurogenic bladder, or other chronic urological conditions. These kits improve infection control by minimizing the risk of contamination during catheter insertion.
## **Documentation requirements**
For A4353 to be covered by Medicare, the patient must have a permanent impairment of urination, such as permanent urinary incontinence or permanent urinary retention.
In addition to a standard written order from a treating practitioner, specific criteria must be documented to justify the use of a sterile kit rather than a standard intermittent catheter (A4351 or A4352) with separate sterile lubricant (A4332).
The medical records must show that the patient meets at least one of the following criteria to support medical necessity:
- The patient resides in a nursing facility.
- The patient is immunosuppressed, which includes conditions like being on an immunosuppressive drug regimen post-transplant, undergoing cancer chemotherapy, or having AIDS.
- The patient has a history of radiologically documented vesico-ureteral reflux while on a program of intermittent catheterization.
- The patient is a female with a spinal cord injury or a spinal cord-injured female who is pregnant (for the duration of the pregnancy only).
- The patient has had two or more distinct, recurrent urinary tract infections (UTIs) in the 12 months prior to starting the sterile catheter kit program, despite using a standard sterile catheter with sterile lubricant. A UTI is defined by a urine culture with more than 10,000 colony-forming units of a urinary pathogen and concurrent signs/symptoms.
## **A4353 billing requirements**
This code, which is used for durable medical equipment (DME) billing, has the following requirements for accurate and timely reimbursement:
- Unbundling is incorrect: The A4353 code is for a complete sterile insertion kit. You cannot bill for the individual insertion kit components of the kit (catheter, lubricant, gloves, etc.) separately. This is considered unbundling.
- Modifier use: The KX modifier is typically used to indicate that the product meets the specific coverage criteria. If the patient does not meet the coverage criteria and the provider believes a denial is expected, a GA or GZ modifier may be used.
- Refills: For refills, the supplier must contact the patient no sooner than 30 days before their current supply is expected to run out and document an affirmative response from the patient that they need the refill. Delivery should then occur no sooner than 10 days before the supply is expected to end.
- Quantity: Medicare may cover up to 200 units of A4353 per month for each episode of reasonable and necessary sterile intermittent catheterization.
## **Other relevant codes**
- A4351: Intermittent urinary catheter, straight tip, with or without coating
- A4352: Intermittent urinary catheter, coude tip, with or without coating
Frequently asked questions
