HCPCS code A4355 – Irrigation tubing set for continuous bladder irrigation

Key takeaways

HCPCS code A4355 covers one irrigation tubing set for continuous bladder irrigation (CBI) through a three-way indwelling Foley catheter, billed per set.

Medicare coverage is governed by LCD L33803 (Urological Supplies) together with Policy Article A52521.

The LCD covers continuous irrigation only when the record shows catheter obstruction that intermittent irrigation could not clear.

A Standard Written Order must reach the supplier before the claim is submitted, and more than one tubing set per day is denied.

A4355 is not separately billable during an inpatient stay, so bill it only for supplies delivered to the patient after discharge.

HCPCS Code A4355: Official descriptor and key attributes

HCPCS code A4355 describes an “Irrigation tubing set for continuous bladder irrigation through a three-way indwelling foley catheter, each.” It is a Level II A-series supply code maintained by CMS under the HCPCS system, within the A4310–A4360 urinary supplies range. Billing is per unit (each tubing set), not per day or per month.

The descriptor anchors to a specific device: a three-way indwelling Foley catheter. That third lumen is what makes simultaneous irrigation inflow and urine outflow possible. A standard two-way Foley does not support CBI, so A4355 cannot be billed when a two-way catheter is documented.

Neighboring catheters, trays and drainage bags each carry their own code, and our HCPCS codes index lists them alongside A4355.

Clinical context: When is continuous bladder irrigation used?

CBI is most frequently ordered after transurethral resection of the prostate (TURP) or other endoscopic bladder procedures, where bleeding creates clot risk. The three-way catheter carries irrigant in, keeps the bladder clear, and drains fluid and clots out through the same device.

The conditions below commonly lead to CBI. LCD L33803 sets no ICD-10 requirement for A4355, so none of these codes qualifies a claim on its own.

• Benign prostatic hyperplasia (BPH) with urinary obstruction: N40.1 (Benign prostatic hyperplasia with lower urinary tract symptoms)
• Hematuria: R31.0 (Gross hematuria), R31.9 (Hematuria, unspecified)
• Postprocedural urinary complications: N99.89 (Other postprocedural complications and disorders of genitourinary system)
• Bladder neck obstruction: N32.0 (Bladder-neck obstruction)
• Malignant neoplasm of the bladder: C67.x, where irrigation follows treatment

Report the diagnosis your records support. The claim still stands on the documented history of catheter obstruction, not on which of these codes appears.

Medicare coverage criteria for A4355

Medicare covers A4355 under the urological supplies benefit when the criteria in LCD L33803 and Policy Article A52521 are met. Coverage applies to supplies delivered to the patient at home. During an inpatient stay, supplies are bundled under the DRG, so billing A4355 separately is incorrect.

• Beneficiary requirement: The patient is enrolled in Medicare Part B and meets the medical necessity test below.
• Medical necessity: The patient has a documented history of catheter obstruction, and intermittent irrigation cannot keep the catheter patent. This is the covered condition for continuous irrigation.
• Order requirement: A Standard Written Order (SWO) must be communicated to the supplier before the claim is submitted. Without it, the claim is denied as not reasonable and necessary.
• Catheter type: Documentation must confirm a three-way indwelling Foley catheter is in place. A two-way catheter makes the code non-payable.
• Quantity limit: The usual maximum is one irrigation tubing set per day. More than one set per day for continuous irrigation is denied as not reasonable and necessary.
• Duration: The LCD treats continuous irrigation as a temporary measure. Use beyond two weeks is rarely reasonable and necessary.
• Advance Beneficiary Notice (ABN): Use one when you expect Medicare to deny an item, such as sets above the daily limit. Without a valid ABN, the supplier generally absorbs the cost of a denial.

These criteria work as a sequence, and a single “no” ends the claim. The checklist below follows that order.

The DMEPOS supplier bills A4355, not the treating physician’s practice. If your urology practice is not a registered DMEPOS supplier, the claim goes through a contracted DME supplier that bills the patient’s DME MAC.

Documentation requirements to support A4355 claims

Missing or incomplete documentation is the leading denial trigger for A4355. Understanding medical billing workflows for DMEPOS supply codes means treating the order and the medical record as the base of every claim.

Every A4355 claim file must contain the following:

1. Standard Written Order (SWO): Received by the supplier before the claim is submitted. It names the beneficiary, dates the order, describes the item and quantity, and carries the treating practitioner’s NPI and signature.
2. Obstruction history: Medical record notes showing the catheter has obstructed and that intermittent irrigation could not keep it patent.
3. Solution rate and duration: The record states the rate of solution administration and how long continuous irrigation is needed.
4. Catheter confirmation: A note in the medical record confirming a three-way indwelling Foley catheter is in active use. This can be a procedure note, discharge summary, or home health nurse visit note.
5. Proof of delivery (POD): A signed delivery document or equivalent confirmation that the patient or caregiver received the supplies.
6. ABN (where applicable): If you expect a denial, such as for sets above the daily limit, file a signed ABN before delivery.

How to bill A4355: Step-by-step claim submission

A4355 is billed by the DMEPOS supplier, not the treating physician’s office. Submitting a clean claim from the start reduces processing time and denial risk.

1. Claim form: CMS-1500 (paper) or 837P electronic transaction. DMEPOS suppliers bill under their own NPI and DMEPOS Medicare supplier number.
2. Place of service: Use POS 12 (home) when supplies are delivered to a beneficiary’s residence. POS varies for assisted living or skilled nursing facilities, so confirm the correct code with your DME MAC.
3. Billed unit: Each tubing set is one unit. Bill the quantity delivered, and no more than one set per day of continuous irrigation.
4. Modifiers: RR (rental) does not apply to a disposable supply like A4355. Check Policy Article A52521 for any modifier the policy requires before you submit.
5. Order match: The NPI, SWO date and quantity on the claim should match the order in the supplier’s file. A mismatch between claim and order invites a denial.

2026 Medicare fee schedule rate for A4355

The Medicare allowable for A4355 is published in the CMS DMEPOS fee schedule. Rates update each January 1, so pull the current rate directly from CMS before quoting reimbursement.

Key points for 2026 billing:

• State-level rates: The DMEPOS fee schedule lists allowables by state. Read the row for the state where the beneficiary lives.
• Competitive bidding: Check whether a DMEPOS Competitive Bidding Program round in effect includes A4355 in your area. Where one does, the contract amount applies instead of the fee schedule rate.
• Non-Medicare payers: Commercial insurers and Medicaid set their own allowables. These may be higher or lower than Medicare, so verify them in the payer contract or the payer’s fee schedule portal.
• Verification tool: Use the AAPC HCPCS code lookup to confirm the current descriptor and the code’s status before submitting a claim.

Do not hard-code a dollar figure for A4355 into billing templates. The rate changes annually, and a claim built on an outdated amount can trigger a repayment obligation during post-payment review.

A4355 vs. related catheter and irrigation supply codes

The urinary supply codes around A4355 often appear together on post-TURP discharge claims, and billing the wrong one is a frequent audit finding. LCD L33803 lists the covered CBI set as a three-way Foley (A4313, A4316 or A4346), the A4355 tubing set, and sterile water or saline (A4217).

Key rule: A4355 and A4338 cannot logically appear together on the same claim for the same beneficiary on the same date. A4338 is a two-way Foley, and A4355 requires a three-way Foley. If your claim has both, the documentation should show two separate clinical scenarios. Otherwise, one of the codes is wrong.

When the three-way catheter is placed from a tray that includes a drainage bag, the tray bills as A4316 alongside A4355. A tray billed as A4314 points to a two-way catheter, which cannot carry irrigation.

Common claim denial reasons for A4355 and how to avoid them

Most A4355 denials trace back to a handful of root causes. Structured denial management starts with tracking denial reason codes by category. That lets you spot patterns and fix upstream documentation, not only rework individual claims.

Payer-specific policies: DME MACs and commercial insurers

LCD L33803 and Policy Article A52521 apply in all four DME MAC jurisdictions. CGS administers the B and C jurisdictions, while Noridian runs the A and D jurisdictions. Every DME MAC publishes the same LCD and policy article, so the A4355 coverage rules do not change by region.

The claim goes to the DME MAC for the beneficiary’s state. Look up the right contractor on the CMS list of MACs before billing.

Private payers set their own coverage rules. Some mirror LCD L33803, while others apply different quantity limits or require prior authorization. Check the payer contract or the plan’s provider portal before assuming Medicare rules apply.

How claims management software reduces A4355 claim errors

A4355 claims fail on details that are easy to lose between the order, the delivery and the claim. When those details sit in separate spreadsheets and payer portals, a claim can go out before the paperwork is ready.

Pabau, the practice management platform we build, includes claims management software that submits US claims through its Claim.MD integration. Validation checks run in the background before submission, so missing claim details surface before the payer sees them.

That five-stage claim tracker also gives your billing team one view of every open supply claim. A rejected A4355 claim gets reworked while the SWO and delivery records are still fresh.

Catch A4355 claim errors before submission

Pabau’s claims management software submits US claims through Claim.MD, runs validation checks in the background, and tracks each claim through five stages. Your team spots problems on A4355 and other supply claims before they turn into denials.

Book a demo

Conclusion

A4355 is simple to code and easy to lose on documentation. Before each claim, confirm that a three-way Foley is in place and that the SWO arrived first. Then check that the record shows obstruction intermittent irrigation could not clear.

Build those checks into supplier intake rather than claim review. A missing obstruction note caught at intake costs one call to the practitioner, while the same note caught after a denial costs an appeal.

The trade-off is a slower first claim in exchange for fewer reworked ones. Book a demo to see how Pabau’s claim validation and tracking keep A4355 supply claims moving.

Continue your research

Need to understand how supply claim denials get resolved? Denial management in healthcare covers how to build a structured appeals workflow that reduces write-offs on DMEPOS and other supply codes.

Want a cleaner claims process from intake to payment? Submitting a clean claim explains the documentation and billing elements that prevent payer edits before submission.

Looking for end-to-end billing compliance guidance? Medical billing compliance outlines the regulatory standards urology and DMEPOS billing teams must meet under CMS rules.

Billing the drainage bag that goes home with the catheter? HCPCS code A4358 covers the leg and abdomen urinary drainage bag code.

Supplying a bedside bag for overnight drainage? HCPCS code A4357 covers the bedside drainage bag code and how it differs from leg bags.

Frequently asked questions