Summary & Overview
HCPCS Level II A4351: Intermittent Straight-Tip Urinary Catheter
HCPCS Level II code A4351 represents an intermittent straight-tip urinary catheter, available with or without various coatings, used for periodic bladder drainage. Nationally, this durable medical equipment item is a common supply for patients requiring intermittent catheterization due to retention, neurogenic bladder, or other voiding dysfunctions; it affects supply-chain decisions, billing workflows, and DMEPOS coverage policies across payers. Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Readers will gain a concise briefing on what the code denotes, typical clinical contexts where intermittent catheters are used, and how this supply is categorized for billing and site-of-service purposes. The publication outlines payer coverage landscape and common administrative considerations such as rental versus purchase distinctions and related catheter codes. It highlights benchmarks and policy updates relevant to DME urological supplies, coding relationships to neighboring HCPCS entries, and documentation touchpoints used by suppliers and clinical teams. Data not available in the input is noted where applicable. The summary is oriented to billing managers, DME suppliers, and clinicians involved in care coordination and reimbursement processes.
Billing Code Overview
HCPCS Level II code A4351 describes an intermittent urinary catheter, straight tip, with or without coating (for example, Teflon, silicone, silicone elastomer, or hydrophilic), each. This item is classified as durable medical equipment (urological supplies) and is intended for use in managing bladder drainage needs.
Typical site of service is a durable medical equipment supplier or home use (DMEPOS) setting where patients or caregivers obtain the catheter for intermittent bladder catheterization.
Clinical & Coding Specifications
Clinical Context
A patient with chronic urinary retention who performs intermittent self-catheterization receives supplies from a durable medical equipment supplier for home use. The patient presents after a urology visit documenting difficulty emptying the bladder due to neuromuscular bladder dysfunction and recurrent urinary tract infections. A urology physician or authorized clinician orders single-use straight-tip intermittent urinary catheters for ongoing clean intermittent catheterization at home. The DMEPOS supplier dispenses HCPCS Level II code A4351 catheters, documents the order, verifies medical necessity with the payer, and provides patient instruction on catheter insertion, storage, and safe disposal. Follow-up care may include monitoring for urinary tract infection symptoms and reassessment of catheter type (e.g., straight vs. coude) during clinic visits.
Coding Specifications
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HCPCS Level II code:
A4351— Intermittent urinary catheter; straight tip, with or without coating, each. -
Common modifiers:
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NU— New Equipment -
Use when the item is initial issue to the patient as new equipment from the DME supplier.
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RR— Rental -
Use when the catheter or related supply is furnished as a rental per payer/rental policy.
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Provider taxonomies and specialties:
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208800000X— Urology Physician -
363LF0000X— Nurse Practitioner, Family -
363LA2200X— Physician Assistant, Medical
Related Diagnoses
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N39.0— Urinary tract infection, site not specified -
Relevance: UTIs are a common concern for patients who perform catheterization; documentation of infection may influence supply needs and frequency of monitoring.
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R33.9— Retention of urine, unspecified -
Relevance: Urinary retention is a primary indication for intermittent catheterization and justifies provision of
A4351supplies. -
N31.9— Neuromuscular dysfunction of bladder, unspecified -
Relevance: Neuromuscular bladder dysfunction can cause incomplete emptying or retention, indicating need for intermittent catheterization with
A4351. -
N13.9— Obstructive and reflux uropathy, unspecified -
Relevance: Obstructive uropathy may impair urine flow and lead to use of intermittent catheters as a management strategy.
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R35.0— Frequency of micturition -
Relevance: Frequency may accompany underlying bladder dysfunction or infection; catheterization supplies like
A4351can be part of the management plan.
Related Codes
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A4352— Intermittent urinary catheter, coude (curved) tip -
Relevance: Alternative catheter tip option for patients who require a curved tip to negotiate anatomic obstruction; used as an alternative to
A4351when clinically indicated. -
A4338— Indwelling catheter; Foley type, two-way latex -
Relevance: Represents an indwelling (Foley) catheter option used when continuous bladder drainage is required; may be used instead of intermittent catheters in certain clinical scenarios.
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A4310— Insertion tray without drainage bag and catheter -
Relevance: Supplies used during catheter insertion procedures; may be provided along with intermittent catheters for sterile insertion when clinically indicated.
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A4311— Insertion tray with drainage bag and catheter -
Relevance: Similar insertion kit that includes a drainage bag; may be used in workflows requiring collection during or after catheter placement.
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A4331— Extension drainage tubing, any type -
Relevance: Ancillary supply that can be used with indwelling catheters or drainage systems; less commonly used with single-use intermittent catheters but part of the broader urologic supply set.
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Common pairings and alternatives:
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A4351andA4352are clinical alternatives for intermittent catheterization based on tip configuration. -
A4351vsA4338: intermittent catheter (A4351) is used for clean intermittent catheterization; indwelling Foley (A4338) is an alternative when intermittent catheterization is not appropriate. -
A4310/A4311may be supplied in conjunction with catheter procedures when insertion kits are required.
National Reimbursement Benchmarks
National mean allowed rates for HCPCS Level II code A4351 place Medicare at $1.00 compared with the BUCA (average commercial) mean of $1.707282657354, indicating commercial plans on average reimburse above the Medicare rate for this code. Blue Cross Blue Shield reports the highest national mean at $2.342283717643 while Aetna and Cigna are closer to the Medicare level.
Rate dispersion (P75 minus P25) is tightest for Cigna Health and Medicare (both effectively $0.00 range) and Aetna (range $0.25), indicating concentration around the median for those payers. The widest dispersion is for Blue Cross Blue Shield (range $1.00) and UnitedHealthcare (range $1.00), with BUCA showing a moderate dispersion (~$0.83). The table and chart below present the full breakdown.
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