An A4351 catheter is an intermittent urinary catheter, with a straight tip, and with or without coating (Teflon, silicone, silicone elastomeric, or hydrophilic).

Intermittent catheters are covered to drain urine from the bladder for a patient who has permanent urinary retention. Permanent urinary retention is defined as when a patient is not expected to be medically or surgically cured within three months. For each catheterization episode, Medicare will cover one catheter (A4351 or A4352) and an individual packet of lubrication (A4332).

Patients can get up to 200 intermittent catheters each month.

For the full and most up-to-date policy, please visit www.cms.gov and search "L33803".

An A4352 catheter is an intermittent urinary catheter, with a coudé (curved) tip, and with or without coating (Teflon, silicone, silicone elastomeric, or hydrophilic).

Intermittent catheters are covered to drain urine from the bladder for a patient who has permanent urinary retention. Permanent urinary retention is defined as when a patient is not expected to be medically or surgically cured within three months. For each catheterization episode, Medicare will cover one catheter (A4351 or A4352) and an individual packe of lubrication (A4332).

A coudé tip catheter for females is rarely needed and justified. When a coudé tip catheter is prescribed, medical necessity must be documented in the medical record. An example would be the inability to catheterize with a straight tip catheter.

Patients can get up to 200 intermittent catheters each month.

For the full and most up-to-date policy, please visit www.cms.gov and search "L33803".

An A4353 catheter is an intermittent urinary catheter with insertion supplies (kit), which includes a catheter and all supplies necessary for a single, sterile insertion.

Intermittent catheterization using a sterile intermittent catheter kit (A4353) is covered when a patient requires catheterization and meets one of the following criteria:

1. Lives in a nursing facility
2. Is immunosuppressed
3. Has vesico-ureteral reflux
4. Is a pregnant spinal cord injured female with neurogenic bladder
5. Has had two or more urinary tract infections (UTI) during a 12-month period while using sterile intermittent catheterization with A4351/A4352 and sterile lubricant A4332

A patient would be considered to have a urinary tract infection if they have a urine culture with greater than 10,000 colony forming units of a urinary pathogen AND concurrent presence of one or more of the following signs, symptoms or laboratory findings:

•  Fever (oral temperature greater than 38º C [100.4º F])
•  Systemic leukocytosis
•  Change in urinary urgency, frequency, or incontinence
•  Appearance of new or increase in autonomic dysreflexia (sweating, bradycardia, blood pressure elevation)
•  Physical signs of prostatitis, epididymitis, orchitis
•  Increased muscle spasms
•  Pyuria (greater than 5 white blood cells [WBCs] per high-powered field)

Patients can get up to 200 intermittent catheters each month.

For the full and most up-to-date policy, please visit www.cms.gov and search “L33803”.