{"id":162193,"date":"2026-07-23T09:43:13","date_gmt":"2026-07-23T09:43:13","guid":{"rendered":"https:\/\/pabau.com\/?p=162193"},"modified":"2026-08-13T12:03:17","modified_gmt":"2026-08-13T12:03:17","slug":"hcpcs-code-a4351","status":"publish","type":"post","link":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/","title":{"rendered":"HCPCS Code A4351: Intermittent urinary catheter billing guide"},"content":{"rendered":"\n<script type=\"application\/ld+json\">{\"@context\":\"https:\/\/schema.org\",\"@type\":\"MedicalWebPage\",\"headline\":\"HCPCS Code A4351: Intermittent urinary catheter billing guide\",\"description\":\"HCPCS Code A4351 covers intermittent urinary catheters with a straight tip. Learn Medicare coverage criteria, documentation requirements, fee schedule rates, and the 2026 hydrophilic coding update.\",\"url\":\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4351\/\",\"audience\":{\"@type\":\"MedicalAudience\",\"audienceType\":\"Clinician\"},\"reviewedBy\":{\"@type\":\"Person\",\"name\":\"Dr Vanja Kitanova\",\"jobTitle\":\"Medical Reviewer\",\"affiliation\":{\"@type\":\"Organization\",\"name\":\"Pabau\"},\"knowsAbout\":[\"Medical Coding\",\"Clinical Documentation\",\"Healthcare Billing\",\"Clinical Safety\"],\"sameAs\":\"https:\/\/pabau.com\/blog\/author\/vanja\/\"},\"datePublished\":\"2026-07-09\",\"dateModified\":\"2026-07-09\"}<\/script>\n\n\n        <div id=\"key_takeaways\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/12\/Key-Takeaways-Icon.svg\" alt=\"Key Takeaways\" height=\"42\" width=\"42\">\n                                <h3>Key Takeaways<\/h3>\n            <\/div>\n            <div class=\"list\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>HCPCS Code A4351 describes an intermittent urinary catheter with a straight tip, with or without a teflon or silicone coating, billed under Medicare&#8217;s DME benefit.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Coverage requires a physician order documenting medical necessity under LCD L33803; eligible diagnoses include urinary retention, spinal cord injury, and neurogenic bladder.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>A4351 remains active for non-hydrophilic straight-tip catheters; hydrophilic-coated catheters move to new code A4295 for dates of service on or after January 1, 2026.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#3D3D46\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p>Pabau&#8217;s claims management software helps DME suppliers and clinical practices track documentation requirements and reduce A4351 claim denials.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-hcpcs-code-a4351-definition-and-clinical-description\" class=\"wp-block-heading\">HCPCS Code A4351: Definition and clinical description<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">HCPCS Code A4351 is a Level II HCPCS code for an intermittent urinary catheter with a straight tip, billed under Medicare Part B and other payers as durable medical equipment (DME). Teflon, silicone, and uncoated straight-tip catheters bill under A4351; hydrophilic-coated straight-tip catheters bill separately under new code A4295 for dates of service on or after January 1, 2026.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">This guide covers the official descriptor, Medicare coverage criteria under LCD L33803, documentation requirements, 2026 fee schedule rates, and the hydrophilic coding update.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A4351 is one of the most frequently miscoded urological supply codes, because the boundaries between A4351, A4352, and A4353 determine reimbursement accuracy. Wrong code selection and incomplete physician documentation are the leading causes of DME claim denials for these supplies.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The Centers for Medicare and Medicaid Services (<a href=\"https:\/\/www.cms.gov\/medicare\/coding-billing\/healthcare-common-procedure-system\" target=\"_blank\" rel=\"nofollow noopener\">CMS<\/a>) updates HCPCS Level II codes annually, so verify the current descriptor before submitting claims.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4;min-width:140px\">Field<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A4351<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Full descriptor<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, etc.)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Code type<\/td>\n<td style=\"padding:12px 16px;color:#374151\">HCPCS Level II (DME supply)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Applicable payer<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Medicare Part B, Medicaid, commercial insurers<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Product category<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Urological supplies \/ Durable Medical Equipment (DME)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">LCD governing coverage<\/td>\n<td style=\"padding:12px 16px;color:#374151\">LCD L33803 (Urological Supplies)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Related codes<\/td>\n<td style=\"padding:12px 16px;color:#374151\">A4352 (coude tip), A4353 (with insertion supplies)<\/td>\n<\/tr>\n<tr style=\"background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">2026 status<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Active for non-hydrophilic catheters; hydrophilic-coated catheters move to A4295 for DOS on or after January 1, 2026<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The straight tip design distinguishes A4351 from A4352, which covers a coude (curved) tip. Teflon and silicone coatings still fall within the A4351 descriptor.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Hydrophilic coating doesn&#8217;t: for dates of service on or after January 1, 2026, hydrophilic-coated straight-tip catheters bill under new code A4295, not A4351. Confirming the coating type on the supplied product before billing prevents coding errors that trigger claim audits.<\/p>\n\n\n\n<h2 id=\"h-medicare-coverage-criteria-for-urological-supplies-under-lcd-l33803\" class=\"wp-block-heading\">Medicare coverage criteria for urological supplies under LCD L33803<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare coverage for intermittent urinary catheter supplies is governed by <a href=\"https:\/\/www.cms.gov\/medicare-coverage-database\/view\/lcd.aspx?LCDId=33803\" target=\"_blank\" rel=\"nofollow noopener\">Local Coverage Determination L33803<\/a>, which sets the indications, limitations, and documentation requirements for A4351 claims. Coverage is not automatic. The patient must have a documented medical condition requiring intermittent catheterization, and the treating physician must certify medical necessity in writing.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Good documentation practices become critical here. A physician order lacking the required elements is the single most common reason A4351 claims are denied on post-payment audit.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Coverage indications under LCD L33803:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urinary retention requiring catheterization (e.g., spinal cord injury, multiple sclerosis, diabetic neuropathy)<\/li>\n\n\n\n<li>Neurogenic bladder documented by urodynamic testing or physician diagnosis<\/li>\n\n\n\n<li>Urethral obstruction not amenable to surgical correction<\/li>\n\n\n\n<li>Post-surgical urinary retention when long-term catheterization is expected<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Coverage exclusions:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Temporary post-operative catheterization (short-term use)<\/li>\n\n\n\n<li>Foley\/indwelling catheters billed under separate codes<\/li>\n\n\n\n<li>Patients who are not performing self-catheterization or being catheterized by a caregiver at home<\/li>\n<\/ul>\n\n\n\n<h3 id=\"h-icd-10-codes-that-support-a4351-claims\" class=\"wp-block-heading\">ICD-10 codes that support A4351 claims<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Every A4351 claim requires a supporting ICD-10-CM diagnosis code establishing medical necessity. The ICD-10 codes listed below are among those covered under LCD L33803. This is not an exhaustive list; verify the full covered diagnosis set against the current LCD before submitting claims.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4;min-width:140px\">ICD-10-CM Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Description<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">R33.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Retention of urine, unspecified<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N31.9<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Neuromuscular dysfunction of bladder, unspecified<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G82.20<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Paraplegia, unspecified (spinal cord injury)<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">G35<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Multiple sclerosis<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">E11.42<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Type 2 diabetes mellitus with diabetic polyneuropathy<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">N36.44<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Muscular disorders of urethra<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Q64.39<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Other atresia and stenosis of urethra and bladder neck<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">Always use the most specific ICD-10 code available for the patient&#8217;s condition. Using an unspecified code (e.g., R33.9) when a more specific code is documented risks claim rejection under medical necessity review. Maintaining accurate patient clinical records with the documented diagnosis tied to the catheterization order is the foundation of a clean claim.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-a4351\/comprehensive-patient-records.webp\" alt=\"Comprehensive patient records\"\/><figcaption class=\"wp-element-caption\"><em>Comprehensive patient records<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h2 id=\"h-documentation-requirements-for-billing-a4351\" class=\"wp-block-heading\">Documentation requirements for billing A4351<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A Medicare audit of A4351 claims will request the physician order, the medical necessity documentation, and proof that the quantity billed matches the documented catheterization frequency. Missing any one of these will result in recoupment. The HIPAA compliance standards that govern patient records apply equally to DME supplier records supporting these claims.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Required physician order elements:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patient name and date of birth<\/li>\n\n\n\n<li>Diagnosis code(s) establishing medical necessity<\/li>\n\n\n\n<li>Specific catheter type ordered (straight tip intermittent)<\/li>\n\n\n\n<li>Frequency of catheterization per day<\/li>\n\n\n\n<li>Estimated duration of need<\/li>\n\n\n\n<li>Physician name, NPI, signature, and date<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Medical necessity documentation in the patient file:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Urodynamic study results (when neurogenic bladder is the indication) or clinical notes documenting retention<\/li>\n\n\n\n<li>Confirmation that the patient or caregiver is trained and capable of performing catheterization<\/li>\n\n\n\n<li>Documentation that conservative management (medication, timed voiding) was attempted or is not appropriate<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that struggle with documentation completeness often benefit from structured intake workflows. Strong patient compliance documentation also supports ongoing medical necessity at recertification.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-a4351\/medical-forms-new-medical-form-with-components-2x.webp\" alt=\"Medical Forms New Medical Form With Components@2x\"\/><figcaption class=\"wp-element-caption\"><em>Medical Forms New Medical Form With Components@2x<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Request a written order renewal every 12 months for patients on long-term intermittent catheter programs. LCD L33803 requires updated physician documentation when supplies are ordered beyond the initial authorization period. Build renewal reminders into your scheduling workflow so orders never lapse before the next supply shipment.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<p class=\"wp-block-paragraph\">The <a href=\"https:\/\/pabau.com\/blog\/best-medical-practice-management-software\/\">best medical practice management systems<\/a> tie supply usage to invoices, so dressing changes stop being free.<\/p>\n\n\n\n<h2 id=\"h-a4351-medicare-fee-schedule-and-reimbursement-rates-2026\" class=\"wp-block-heading\">A4351 Medicare fee schedule and reimbursement rates 2026<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Medicare reimbursement for HCPCS Code A4351 is set through the DME fee schedule administered by CMS. Rates are updated annually and vary by region under the standard jurisdictional fee schedule; urological supplies aren&#8217;t part of the DMEPOS Competitive Bidding Program.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Use the <a href=\"https:\/\/www.cms.gov\/medicare\/physician-fee-schedule\/search\/overview\" target=\"_blank\" rel=\"nofollow noopener\">fee schedule lookup tool<\/a> to confirm current allowable rates for your specific jurisdiction before quoting patients or submitting claims.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The table below shows illustrative rate ranges based on publicly available Medicare DME fee schedule data. Actual rates vary by region and jurisdiction. Always verify against the current CMS DME fee schedule file before billing.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4;min-width:140px\">Rate Type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Details<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Reimbursement basis<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Standard jurisdictional DME fee schedule; urological supplies are not part of the DMEPOS Competitive Bidding Program, unlike categories such as off-the-shelf back and knee braces<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Billing unit<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Per catheter (each); quantity billed must match documented catheterization frequency<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Patient coinsurance<\/td>\n<td style=\"padding:12px 16px;color:#374151\">20% of Medicare-approved amount (after deductible); Medigap may cover remainder<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">Assignment<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Participating suppliers must accept assignment and bill Medicare directly; non-participating suppliers may bill the patient directly, since the Medicare limiting charge cap that applies to physician services does not apply to DME<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<h3 id=\"h-quantity-limits-and-utilization-guidelines\" class=\"wp-block-heading\">Quantity limits and utilization guidelines<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">LCD L33803 sets monthly quantity limits for intermittent catheters. Exceeding these limits without documentation of medical necessity will trigger automatic claim edits and denials.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Standard quantity limit:<\/strong> Up to 200 catheters per month (approximately 4-6 per day for a 30-day period), based on typical catheterization frequency for most conditions<\/li>\n\n\n\n<li><strong>Exceeding standard limits:<\/strong> Requires the KX modifier and supporting documentation in the patient record showing catheterization frequency exceeds the standard limit<\/li>\n\n\n\n<li><strong>Pediatric patients:<\/strong> Quantity limits may differ; verify against the specific LCD and MAC policy for pediatric urological supplies<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">When neither the quantity nor the documentation on file will support a claim, having the patient sign a Medicare waiver before the catheters go out protects the supplier from absorbing the cost of a predictable denial.<\/p>\n\n\n\n<h3 id=\"h-billing-modifiers-used-with-hcpcs-code-a4351\" class=\"wp-block-heading\">Billing modifiers used with HCPCS Code A4351<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Modifier selection is where many A4351 claims run into trouble. The wrong modifier (or a missing one) can result in claim rejection, payment at a lower rate, or an audit flag. The <a href=\"https:\/\/www.aapc.com\/codes\/hcpcs-codes-range\/\" target=\"_blank\" rel=\"nofollow noopener\">AAPC HCPCS code reference<\/a> provides modifier guidance alongside code descriptors.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4;min-width:100px\">Modifier<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">When to use<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Consequence of omission<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">KX<\/td>\n<td style=\"padding:12px 16px;color:#374151\">When medical necessity documentation is on file and meets LCD criteria; also required when quantity exceeds standard limits<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Claim denied; no payment without KX on most A4351 claims<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">RA<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Replacement of a supply item (e.g., catheter damaged in transit, defective product)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Claim may be rejected as a duplicate if RA is omitted on a replacement billing<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">KS<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Glucose monitor supply (not applicable to A4351, but commonly confused in mixed DME billing)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Incorrect modifier application results in claim edit and rework<\/td>\n<\/tr>\n<tr style=\"background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">EY<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No physician order on file for items or services; signals to Medicare that the supplier acknowledges the order is missing<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Claim denied; EY is not a workaround but a formal acknowledgment of non-coverage<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The KX modifier is the most consequential for A4351 claims. Suppliers often add KX reflexively, but doing so without the required documentation in the patient file constitutes a compliance risk. The documentation must exist before the modifier is applied. Integrated claims management software helps practices enforce modifier rules at the point of claim generation rather than catching errors after denial.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img decoding=\"async\" src=\"https:\/\/cdn.pabau.com\/cdn\/attachments\/pulse\/content-engine\/billing_codes\/hcpcs-code-a4351\/automate-claims-through-healthcode.webp\" alt=\"Automate claims and billing with Pabau\"\/><figcaption class=\"wp-element-caption\"><em>Automate claims and billing with Pabau<\/em><\/figcaption><\/figure>\n\n\n\n<div style=\"height:20px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n        <div id=\"book_a_demo\">\n            <div class=\"left-side\">\n                <div class=\"logo\">\n                    <img decoding=\"async\"\n                        src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Logo.svg\"\n                        alt=\"Logo\"\n                        loading=\"lazy\"\n                    \/>\n                <\/div>\n\n                <h3 class=\"heading\">\n                    Reduce DME claim denials with cleaner documentation                <\/h3>\n\n                <p class=\"description\">\n                    Pabau helps clinical practices track physician order requirements, document medical necessity, and manage DME billing workflows, so A4351 and related supply claims go out complete the first time.                <\/p>\n\n                <div class=\"button-group\">\n                    <a href=\"\/book-demo\/\" class=\"btn btn-scale-effect btn-cta-color btn-md\">\n                        <span class=\"btn-text\">Book a demo<\/span>\n                        <div class=\"btn-icon btn-icon-right\" aria-hidden=\"true\">\n                            <svg\n                                width=\"14\"\n                                height=\"12\"\n                                viewBox=\"0 0 14 12\"\n                                fill=\"none\"\n                                xmlns=\"http:\/\/www.w3.org\/2000\/svg\"\n                            >\n                                <path\n                                    d=\"M0.75 4.77295C0.335786 4.77295 0 5.10874 0 5.52295C0 5.93716 0.335786 6.27295 0.75 6.27295V5.52295V4.77295ZM13.2803 6.05328C13.5732 5.76039 13.5732 5.28551 13.2803 4.99262L8.50736 0.219648C8.21447 -0.073245 7.73959 -0.073245 7.4467 0.219648C7.15381 0.512542 7.15381 0.987415 7.4467 1.28031L11.6893 5.52295L7.4467 9.76559C7.15381 10.0585 7.15381 10.5334 7.4467 10.8263C7.73959 11.1191 8.21447 11.1191 8.50736 10.8263L13.2803 6.05328ZM0.75 5.52295V6.27295L12.75 6.27295V5.52295V4.77295L0.75 4.77295V5.52295Z\"\n                                    fill=\"currentColor\"\n                                ><\/path>\n                            <\/svg>\n                        <\/div>\n                    <\/a>\n                <\/div>\n            <\/div>\n\n            <div class=\"right-side\">\n                <img decoding=\"async\"\n                    src=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/01\/Home-Page-Concept-4.webp\"\n                    alt=\"Pabau claims management dashboard\"\n                    loading=\"lazy\"\n                \/>\n            <\/div>\n        <\/div>\n        \n\n\n<h2 id=\"h-a4351-vs-a4352-vs-a4353-how-to-choose-the-right-code\" class=\"wp-block-heading\">A4351 vs A4352 vs A4353: How to choose the right code<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Selecting the wrong code from the A4351\/A4352\/A4353 group is one of the most common intermittent catheter billing errors. Each code describes a specific product configuration.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Billing A4351 for a coude-tip catheter ordered by the physician, for example, is a coding inaccuracy that creates a mismatch between the claim and the medical record.<\/p>\n\n\n\n<table style=\"width:100%;border-collapse:separate;border-spacing:0;border-radius:12px;overflow:hidden;font-size:15px;line-height:1.5;margin:1.5em 0 2em;box-shadow:0 2px 12px rgba(0,0,0,0.08)\">\n<thead>\n<tr>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4;min-width:120px\">Code<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Tip type<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Includes insertion supplies?<\/th>\n<th style=\"background:#121D36;color:#fff;padding:14px 16px;text-align:left;font-weight:600;font-size:14px;letter-spacing:0.3px;border-bottom:2px solid #2BADD4\">Typical clinical indication<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4351<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Straight tip<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Standard intermittent catheterization; urinary retention, neurogenic bladder<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0;background:#F9FAFB\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4352<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Coude (curved) tip<\/td>\n<td style=\"padding:12px 16px;color:#374151\">No<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Urethral obstruction or enlarged prostate where straight tip cannot pass<\/td>\n<\/tr>\n<tr style=\"border-bottom:1px solid #E8ECF0\">\n<td style=\"padding:12px 16px;font-weight:600;color:#121D36\">A4353<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Straight or coude tip<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Yes (insertion supplies included)<\/td>\n<td style=\"padding:12px 16px;color:#374151\">Patients who require sterile or closed-system catheterization technique with a full kit<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n<p class=\"wp-block-paragraph\">The key decision rule: if the physician order specifies a straight-tip catheter without an insertion kit, A4351 is the correct code. If the order specifies a coude tip, use A4352.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If insertion supplies (drainage bag, collection container, antiseptic wipes) are bundled in a closed system kit, use A4353. Never unbundle A4353 by billing A4351 plus separate supply codes for items already included in the kit descriptor.<\/p>\n\n\n\n<h2 id=\"h-2026-hcpcs-coding-update-hydrophilic-catheters-get-new-codes\" class=\"wp-block-heading\">2026 HCPCS coding update: Hydrophilic catheters get new codes<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The most consequential coding development for intermittent catheters in 2026 is a carve-out for hydrophilic-coated products, not a wholesale replacement of A4351, A4352, and A4353. According to <a href=\"https:\/\/med.noridianmedicare.com\/web\/jadme\/policies\/dmd-articles\/2025\/documentation-requirements-for-new-urological-supplies-codes\" target=\"_blank\" rel=\"nofollow noopener\">Noridian&#8217;s MAC guidance<\/a>, CMS created three new HCPCS codes effective January 1, 2026, exclusively for hydrophilic-coated intermittent catheters: A4295 (hydrophilic straight tip), A4296 (hydrophilic coude tip), and A4297 (hydrophilic insertion-supply kit).<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A4351, A4352, and A4353 remain active. They continue to cover the same three configurations for teflon, silicone, and uncoated catheters. Only the hydrophilic-coated versions move to the new codes for claims with dates of service on or after January 1, 2026.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Confirm the exact new code descriptors against the final CMS HCPCS 2026 release file, since the Noridian article reflects MAC-level guidance that should be checked against the national CMS code set.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>What providers must do:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Confirm whether the catheters a patient uses are hydrophilic-coated before selecting a code for dates of service on or after January 1, 2026<\/li>\n\n\n\n<li>Bill hydrophilic-coated straight-tip catheters under A4295, hydrophilic coude-tip catheters under A4296, and hydrophilic insertion kits under A4297<\/li>\n\n\n\n<li>Continue billing non-hydrophilic straight-tip, coude-tip, and kit catheters under A4351, A4352, and A4353 as before<\/li>\n\n\n\n<li>Update charge master and billing system crosswalk tables so hydrophilic products route to the new codes without disturbing non-hydrophilic claims<\/li>\n\n\n\n<li>Re-verify that physician orders specify coating type, since orders that don&#8217;t distinguish hydrophilic from non-hydrophilic catheters may need an addendum<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Practices that integrate their billing workflow with their clinical documentation systems have an advantage during this kind of coding update. When EHR integration is in place, charge capture rules can be updated centrally, reducing the risk of staff billing the wrong hydrophilic-versus-non-hydrophilic code for a given date of service.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The efficiencies that save time during coding updates often come down to having one system of record rather than parallel manual processes.<\/p>\n\n\n\n<h2 id=\"h-common-billing-errors-and-how-to-avoid-them\" class=\"wp-block-heading\">Common billing errors and how to avoid them<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">A4351 claims have a higher-than-average denial rate among DME supply codes.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Understanding where claims fail helps billing teams build preventative checks into the pre-submission workflow, and directly affects whether a practice collects on its intermittent catheter claims or absorbs write-offs.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Missing KX modifier:<\/strong> A4351 claims submitted without KX are denied automatically by Medicare claims processing systems. The fix is a pre-submission modifier check that runs before claims batch. Implementing systematic billing controls reduces this error to near zero.<\/li>\n\n\n\n<li><strong>Quantity exceeds limit without documentation:<\/strong> Billing more than the standard monthly quantity without KX and supporting frequency documentation triggers a medical necessity denial. Document the catheterization schedule in the patient chart and reference it in the physician order.<\/li>\n\n\n\n<li><strong>Wrong code for product supplied:<\/strong> Billing A4351 when the supplier shipped a coude-tip catheter (A4352) creates a mismatch between the claim and the delivery record. Verify the product actually shipped against the billed code before submission.<\/li>\n\n\n\n<li><strong>Stale physician order:<\/strong> Orders more than 12 months old without renewal are a common audit finding. Establish a renewal workflow tied to the patient&#8217;s supply authorization calendar.<\/li>\n\n\n\n<li><strong>Unbundling A4353:<\/strong> Billing A4351 plus separate supply codes for items that come bundled in a closed-system kit (A4353) is an upcoding risk. When the physician orders a kit, use A4353, not A4351 plus individual supply codes.<\/li>\n\n\n\n<li><strong>Billing hydrophilic catheters under A4351 after the carve-out:<\/strong> A4351 stays valid for non-hydrophilic catheters, but hydrophilic-coated straight-tip catheters supplied for dates of service on or after January 1, 2026 must move to A4295. Continuing to bill hydrophilic products under A4351 creates a code-versus-product mismatch that surfaces on audit. Update the charge master to route hydrophilic products correctly while leaving non-hydrophilic A4351, A4352, and A4353 billing unchanged. Practices managing HIPAA-compliant billing software integrations should test the crosswalk update in a staging environment before go-live.<\/li>\n<\/ul>\n\n\n        <div id=\"pro_tip\">\n            <div class=\"img\">\n                <svg width=\"42\" height=\"42\" viewBox=\"0 0 42 42\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M12.6383 19.5238C12.6632 21.2071 12.8734 22.9926 12.0685 24.5523C11.0341 26.8917 8.45076 28.169 7.56292 30.5918C6.63082 33.1061 7.19505 36.185 9.31371 37.9786C10.929 39.5678 13.4183 39.9873 15.6061 39.5463C17.4592 39.073 19.1049 37.8388 19.9706 36.1608C20.781 34.7141 20.7866 32.9904 20.5293 31.3985C20.1006 29.3092 18.3775 27.8705 16.9807 26.362C14.8814 24.1005 14.6684 20.6854 15.595 17.8915C16.4331 15.4768 19.0026 14.2344 20.0425 11.9461C20.7202 10.6769 20.7506 9.20327 20.6068 7.81304C20.1864 5.40098 18.3139 3.23631 15.8716 2.56674C13.9742 2.03969 11.8224 2.30052 10.1739 3.37614C8.70522 4.34688 7.5878 5.86618 7.28356 7.58178C6.76081 9.82981 7.53525 12.2822 9.20307 13.9118C10.7658 15.4741 12.4806 17.2273 12.6383 19.5238Z\"\n                        fill=\"#2BADD4\" \/>\n                    <path fill-rule=\"evenodd\" clip-rule=\"evenodd\"\n                        d=\"M22.7048 19.8387C22.6822 22.3279 24.4507 24.6234 26.7493 25.4682C28.0531 25.961 29.4725 25.9183 30.7989 25.5487C32.0575 24.9955 33.301 24.2237 34.0069 23.0092C34.8384 21.5811 35.2982 19.8286 34.7832 18.2094C34.3611 16.2507 32.8739 14.6541 31.0275 13.9426C28.6736 12.9595 25.8073 13.7942 24.1719 15.7001C23.2022 16.8366 22.6143 18.3326 22.7048 19.8387Z\"\n                        fill=\"#2BADD4\" \/>\n                <\/svg>\n            <\/div>\n            <div class=\"text\">\n                <h3>Pro Tip<\/h3>\n                <p>Run a pre-submission claim scrub specifically for urological supply codes at least quarterly. Filter for A4351 claims missing KX, claims where quantity exceeds 200 units per month without KX documentation, and any A4351 line items billed alongside A4353 for the same patient and date range. These three edits catch the majority of A4351 denial patterns before they leave your billing system.<\/p>\n            <\/div>\n        <\/div>\n    \n\n\n<h2 id=\"h-the-bottom-line-on-a4351-billing\" class=\"wp-block-heading\">The bottom line on A4351 billing<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Intermittent catheter billing under HCPCS Code A4351 requires more precision than many DME supply codes. The combination of LCD L33803 documentation requirements, quantity limit edits, mandatory KX modifier use, and the 2026 hydrophilic coding update creates multiple points where claims can fail.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Getting each element right, from the physician order through to modifier application, is what separates practices with clean A4351 claim rates from those absorbing recurring denials.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pabau&#8217;s claims management software helps practices build these documentation checks directly into their billing workflows, so orders are complete before claims go out. To see how Pabau handles DME billing documentation for clinical practices, <a href=\"https:\/\/pabau.com\/book-demo\/\">book a demo<\/a> with the team.<\/p>\n\n\n        <div id=\"expert_picks\">\n            <div class=\"header\">\n                                    <img decoding=\"async\" src=\"https:\/\/pabau.com\/wp-content\/uploads\/2025\/11\/Expert-Picks.svg\" alt=\"Continue your research\" height=\"42\" width=\"42\">\n                                <h3>Continue your research<\/h3>\n            <\/div>\n            <div class=\"content\">\n                                                            <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need a compliant release form for DME supplier records?<\/strong> <a href=\"https:\/\/pabau.com\/templates\/authorization-for-release-of-protected-health-information\/\" target=\"_blank\" rel=\"noopener\">PHI authorization template<\/a> covers the core elements auditors look for in a release-of-information form.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Billing other DME supplies bundled under a consolidated payment system?<\/strong> <a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4728\/\" target=\"_blank\" rel=\"noopener\">A4728<\/a> walks through the ESRD PPS bundling rules that trip up dialysis supply claims.<\/p>\n                        <\/div>\n                                                                                <div class=\"item\">\n                            <div>\n                                <svg width=\"20\" height=\"27\" viewBox=\"0 0 20 27\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n                                    <path\n                                        d=\"M18.6223 14.3857C19.1246 13.8975 19.1246 13.1045 18.6223 12.6162L12.1938 6.36621C11.6915 5.87793 10.8759 5.87793 10.3737 6.36621C9.87143 6.85449 9.87143 7.64746 10.3737 8.13574L14.6125 12.2529H2.28571C1.57455 12.2529 1 12.8115 1 13.5029C1 14.1943 1.57455 14.7529 2.28571 14.7529H14.6085L10.3777 18.8701C9.87545 19.3584 9.87545 20.1514 10.3777 20.6396C10.8799 21.1279 11.6955 21.1279 12.1978 20.6396L18.6263 14.3896L18.6223 14.3857Z\"\n                                        fill=\"#54B2D3\" \/>\n                                <\/svg>\n                            <\/div>\n                            <p><strong>Need the right diagnosis pairing for a claim tied to kidney disease?<\/strong> <a href=\"https:\/\/pabau.com\/diagnostic-codes\/icd-10-code-n08\/\" target=\"_blank\" rel=\"noopener\">N08<\/a> explains why this code must follow the etiology code rather than stand alone.<\/p>\n                        <\/div>\n                                                <\/div>\n        <\/div>\n    \n\n\n<h2 class=\"wp-block-heading\">Related HCPCS codes<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a0427-als-emergency-ambulance-transport\/\">HCPCS code A0427 \u2014 ALS Emergency Ambulance Transport<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4353\/\">HCPCS code A4353 \u2014 Intermittent catheter kit<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4356\/\">HCPCS code A4356 \u2014 External urethral clamp<\/a><\/li>\n\n\n<li><a href=\"https:\/\/pabau.com\/procedure-codes\/hcpcs-code-a4357\/\">HCPCS code A4357 \u2014 Bedside drainage bag<\/a><\/li>\n<\/ul>\n\n\n\n<h2 id=\"h-frequently-asked-questions\" class=\"wp-block-heading\">Frequently asked questions<\/h2>\n\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1784794440161\"><h3 class=\"schema-faq-question\">What does HCPCS Code A4351 cover?<\/h3> <p class=\"schema-faq-answer\">HCPCS Code A4351 is an intermittent urinary catheter with a straight tip, with or without coating such as teflon or silicone. It covers single-use and reusable catheters of the straight-tip configuration used for intermittent catheterization at home, and is billed under Medicare&#8217;s DME benefit governed by LCD L33803.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784794440162\"><h3 class=\"schema-faq-question\">What is the difference between A4351 and A4352?<\/h3> <p class=\"schema-faq-answer\">A4351 covers a straight-tip intermittent urinary catheter, while A4352 covers a coude-tip catheter. The coude tip has a curved or angled end designed to navigate urethral obstructions such as an enlarged prostate. Use A4351 when the physician specifies a straight tip; use A4352 when the order explicitly specifies a coude or curved tip.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784794440163\"><h3 class=\"schema-faq-question\">What ICD-10 codes support A4351 billing?<\/h3> <p class=\"schema-faq-answer\">Common ICD-10-CM codes supporting A4351 include R33.9 (urinary retention, unspecified), N31.9 (neuromuscular dysfunction of bladder), G82.20 (paraplegia due to spinal cord injury), and G35 (multiple sclerosis). The covered diagnosis list is defined in LCD L33803; using a code not on that list will result in non-coverage denial regardless of clinical appropriateness.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784794440164\"><h3 class=\"schema-faq-question\">What are the Medicare quantity limits for A4351?<\/h3> <p class=\"schema-faq-answer\">Medicare typically allows up to 200 straight-tip intermittent catheters per month under LCD L33803, covering patients who catheterize up to approximately 4-6 times per day. Quantities above the standard limit require the KX modifier and documentation in the patient record showing the medically necessary catheterization frequency exceeds the standard allowance.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784794440165\"><h3 class=\"schema-faq-question\">Is A4351 still valid after the 2026 HCPCS code changes?<\/h3> <p class=\"schema-faq-answer\">Yes. A4351 remains an active HCPCS code for non-hydrophilic (teflon, silicone, or uncoated) straight-tip intermittent catheters. The January 1, 2026 change only affects hydrophilic-coated catheters, which now bill under new codes A4295 (straight tip), A4296 (coude tip), or A4297 (insertion-supply kit) instead of A4351, A4352, or A4353. Confirm the coating type on the physician order before selecting a code.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784794440166\"><h3 class=\"schema-faq-question\">What documentation is required to bill A4351?<\/h3> <p class=\"schema-faq-answer\">A4351 billing requires a physician order including the patient&#8217;s diagnosis, catheter type, daily catheterization frequency, duration of need, and physician signature. The patient file must also contain medical necessity documentation (such as urodynamic study results or clinical notes) and evidence that the patient or caregiver can perform catheterization. These records must be retained and available for audit.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1784794440167\"><h3 class=\"schema-faq-question\">What is the LCD governing A4351?<\/h3> <p class=\"schema-faq-answer\">LCD L33803 (Urological Supplies) is the Local Coverage Determination governing Medicare coverage for A4351, A4352, and A4353. It defines covered diagnoses, documentation requirements, quantity limits, and billing instructions for intermittent urinary catheter supplies. Your Medicare Administrative Contractor (MAC) may publish additional articles supplementing LCD L33803 for your jurisdiction.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>HCPCS Code A4351: Definition and clinical description HCPCS Code A4351 is a Level II HCPCS code for an intermittent urinary catheter with a straight tip, billed under Medicare Part B and other payers as durable medical equipment (DME). Teflon, silicone, and uncoated straight-tip catheters bill under A4351; hydrophilic-coated straight-tip catheters bill separately under new code [&hellip;]<\/p>\n","protected":false},"author":77,"featured_media":162192,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_yoast_wpseo_linkdex":"86","_yoast_wpseo_content_score":"30","_yoast_wpseo_is_cornerstone":"","_yoast_wpseo_keywordsynonyms":"[\"\",\"\",\"\",\"\",\"\",\"\"]","_yoast_wpseo_focuskw_text_input":"","_seo_original_html":"","footnotes":""},"categories":[1433,1548],"tags":[1606,1582,1619,2559],"class_list":["post-162193","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-billing-codes","category-hcpcs","tag-dme-billing","tag-hcpcs","tag-hcpcs-billing","tag-urology-billing"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v28.2 (Yoast SEO v28.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>HCPCS Code A4351: Billing rules and 2026 coding update<\/title>\n<meta name=\"description\" content=\"A4351 covers non-hydrophilic straight-tip catheters; hydrophilic-coated catheters move to new code A4295 for DOS after January 1, 2026.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/\" \/>\n<meta property=\"og:locale\" content=\"de_DE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"HCPCS Code A4351: Billing rules and 2026 coding update\" \/>\n<meta property=\"og:description\" content=\"A4351 covers non-hydrophilic straight-tip catheters; hydrophilic-coated catheters move to new code A4295 for DOS after January 1, 2026.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/\" \/>\n<meta property=\"og:site_name\" content=\"Pabau\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/Pabau\/\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-23T09:43:13+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-08-13T12:03:17+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/pabau.com\/wp-content\/uploads\/2026\/07\/hcpcs-code-a4351.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"630\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"Katy Piper\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:site\" content=\"@pabaucrm\" \/>\n<meta name=\"twitter:label1\" content=\"Verfasst von\" \/>\n\t<meta name=\"twitter:data1\" content=\"Katy Piper\" \/>\n\t<meta name=\"twitter:label2\" content=\"Gesch\u00e4tzte Lesezeit\" \/>\n\t<meta name=\"twitter:data2\" content=\"13\u00a0Minuten\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/\"},\"author\":{\"name\":\"Katy Piper\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/#\\\/schema\\\/person\\\/5de22f4ff3ec59b1925ef02dce956d7d\"},\"headline\":\"HCPCS Code A4351: Intermittent urinary catheter billing guide\",\"datePublished\":\"2026-07-23T09:43:13+00:00\",\"dateModified\":\"2026-08-13T12:03:17+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/\"},\"wordCount\":2692,\"publisher\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/hcpcs-code-a4351.webp\",\"keywords\":[\"Dme Billing\",\"Hcpcs\",\"Hcpcs Billing\",\"Urology Billing\"],\"articleSection\":[\"Billing Codes\",\"HCPCS\"],\"inLanguage\":\"de\"},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/\",\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/\",\"name\":\"HCPCS Code A4351: Billing rules and 2026 coding update\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/hcpcs-code-a4351.webp\",\"datePublished\":\"2026-07-23T09:43:13+00:00\",\"dateModified\":\"2026-08-13T12:03:17+00:00\",\"description\":\"A4351 covers non-hydrophilic straight-tip catheters; 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It combines scheduling, electronic health records, clinical forms, payments, marketing automation, reporting, and patient engagement tools into one secure cloud system to help practices streamline operations and grow their business.\",\"foundingDate\":\"2011-10-20\",\"numberOfEmployees\":{\"@type\":\"QuantitativeValue\",\"minValue\":\"201\",\"maxValue\":\"500\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/#\\\/schema\\\/person\\\/5de22f4ff3ec59b1925ef02dce956d7d\",\"name\":\"Katy Piper\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"de\",\"@id\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"url\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"contentUrl\":\"https:\\\/\\\/pabau.com\\\/wp-content\\\/uploads\\\/2026\\\/03\\\/cropped-Snip20260306_177-96x96.png\",\"caption\":\"Katy Piper\"},\"description\":\"Katy Piper is a content writer covering aesthetics, dermatology, and clinic operations, with a knack for making clinical detail feel approachable. Outside of work, she's usually chasing her border collie around muddy fields or hunting down the best flat white in town.\",\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/blog\\\/author\\\/katy-piper\\\/\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440161\",\"position\":1,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440161\",\"name\":\"What does HCPCS Code A4351 cover?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"HCPCS Code A4351 is an intermittent urinary catheter with a straight tip, with or without coating such as teflon or silicone. It covers single-use and reusable catheters of the straight-tip configuration used for intermittent catheterization at home, and is billed under Medicare's DME benefit governed by LCD L33803.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440162\",\"position\":2,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440162\",\"name\":\"What is the difference between A4351 and A4352?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"A4351 covers a straight-tip intermittent urinary catheter, while A4352 covers a coude-tip catheter. The coude tip has a curved or angled end designed to navigate urethral obstructions such as an enlarged prostate. Use A4351 when the physician specifies a straight tip; use A4352 when the order explicitly specifies a coude or curved tip.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440163\",\"position\":3,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440163\",\"name\":\"What ICD-10 codes support A4351 billing?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Common ICD-10-CM codes supporting A4351 include R33.9 (urinary retention, unspecified), N31.9 (neuromuscular dysfunction of bladder), G82.20 (paraplegia due to spinal cord injury), and G35 (multiple sclerosis). The covered diagnosis list is defined in LCD L33803; using a code not on that list will result in non-coverage denial regardless of clinical appropriateness.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440164\",\"position\":4,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440164\",\"name\":\"What are the Medicare quantity limits for A4351?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Medicare typically allows up to 200 straight-tip intermittent catheters per month under LCD L33803, covering patients who catheterize up to approximately 4-6 times per day. Quantities above the standard limit require the KX modifier and documentation in the patient record showing the medically necessary catheterization frequency exceeds the standard allowance.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440165\",\"position\":5,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440165\",\"name\":\"Is A4351 still valid after the 2026 HCPCS code changes?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"Yes. A4351 remains an active HCPCS code for non-hydrophilic (teflon, silicone, or uncoated) straight-tip intermittent catheters. The January 1, 2026 change only affects hydrophilic-coated catheters, which now bill under new codes A4295 (straight tip), A4296 (coude tip), or A4297 (insertion-supply kit) instead of A4351, A4352, or A4353. Confirm the coating type on the physician order before selecting a code.\",\"inLanguage\":\"de\"},\"inLanguage\":\"de\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440166\",\"position\":6,\"url\":\"https:\\\/\\\/pabau.com\\\/de\\\/procedure-codes\\\/hcpcs-code-a4351\\\/#faq-question-1784794440166\",\"name\":\"What documentation is required to bill A4351?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"A4351 billing requires a physician order including the patient's diagnosis, catheter type, daily catheterization frequency, duration of need, and physician signature. The patient file must also contain medical necessity documentation (such as urodynamic study results or clinical notes) and evidence that the patient or caregiver can perform catheterization. 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Outside of work, she's usually chasing her border collie around muddy fields or hunting down the best flat white in town.","url":"https:\/\/pabau.com\/de\/blog\/author\/katy-piper\/"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440161","position":1,"url":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440161","name":"What does HCPCS Code A4351 cover?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"HCPCS Code A4351 is an intermittent urinary catheter with a straight tip, with or without coating such as teflon or silicone. It covers single-use and reusable catheters of the straight-tip configuration used for intermittent catheterization at home, and is billed under Medicare's DME benefit governed by LCD L33803.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440162","position":2,"url":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440162","name":"What is the difference between A4351 and A4352?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"A4351 covers a straight-tip intermittent urinary catheter, while A4352 covers a coude-tip catheter. The coude tip has a curved or angled end designed to navigate urethral obstructions such as an enlarged prostate. Use A4351 when the physician specifies a straight tip; use A4352 when the order explicitly specifies a coude or curved tip.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440163","position":3,"url":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440163","name":"What ICD-10 codes support A4351 billing?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Common ICD-10-CM codes supporting A4351 include R33.9 (urinary retention, unspecified), N31.9 (neuromuscular dysfunction of bladder), G82.20 (paraplegia due to spinal cord injury), and G35 (multiple sclerosis). The covered diagnosis list is defined in LCD L33803; using a code not on that list will result in non-coverage denial regardless of clinical appropriateness.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440164","position":4,"url":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440164","name":"What are the Medicare quantity limits for A4351?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Medicare typically allows up to 200 straight-tip intermittent catheters per month under LCD L33803, covering patients who catheterize up to approximately 4-6 times per day. Quantities above the standard limit require the KX modifier and documentation in the patient record showing the medically necessary catheterization frequency exceeds the standard allowance.","inLanguage":"de"},"inLanguage":"de"},{"@type":"Question","@id":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440165","position":5,"url":"https:\/\/pabau.com\/de\/procedure-codes\/hcpcs-code-a4351\/#faq-question-1784794440165","name":"Is A4351 still valid after the 2026 HCPCS code changes?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"Yes. A4351 remains an active HCPCS code for non-hydrophilic (teflon, silicone, or uncoated) straight-tip intermittent catheters. The January 1, 2026 change only affects hydrophilic-coated catheters, which now bill under new codes A4295 (straight tip), A4296 (coude tip), or A4297 (insertion-supply kit) instead of A4351, A4352, or A4353. 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