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October 31, 2016

Retired: Utilization Reminder: Intermittent Catheters and Sterile Lubricant Packets

The Urological Supplies LCD (L33803) states that the maximum monthly allowance for HCPCS codes A4332 (Individual Sterile Lubricant Packet), A4351 (Straight Tip Intermittent Urinary Catheter), A4352 (Coude [Curved] Tip Intermittent Urinary Catheter) and A4353 (Intermittent Urinary Catheter with Insertion Supplies) is 200 per month. There is no policy provision, even if supporting documentation is provided, to allow payment for additional amounts above 200 units per month or 600 units per three (3) months. Consequently, if the billed quantity of HCPCS code A4332, A4351, A4352 or A4353 is above the maximum monthly allowance, the excess units will be denied as "quantity in excess of reasonable and necessary".

Publication History:

May 2019

Article Retired

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