Urological and Bowel Supplies
Overview
Catheters and related supplies are used to drain urine from the bladder or promote emptying of the contents of the colon when a member is unable to completely empty the bladder by voiding or unable to control their bowel movements.
Eligible Providers
The following may provide catheters and supplies:
TPL and Medicare
Providers must meet any provider criteria, including accreditation, for third party insurance or for Medicare to assist members for whom Minnesota Health Care Programs (MHCP) is not the primary payer.
MHCP quantity limits and thresholds apply to all members unless only Medicare coinsurance or deductible is requested.
Refer to the Medicare and Other Insurance section of the MHCP Provider Manual for more information.
Eligible Members
Urological and bowel supplies are covered for members with Medical Assistance or MinnesotaCare who are unable to completely empty their bladder by voiding or unable to control their bowel movements.
Covered Services
Codes: A4310-A4316, A4320-A4322, A4326-A4328, A4330-A4336, A4338, A4340, A4344, A4346, A4349, A4351-A4358, A4450, A4452, A4453, A4457-A4459, A4479, A4561, A4562, A4564, A5102, A5112-A5114
MHCP covers the following supplies:
Urological and bowel supplies are included in the per diem for members living in a nursing facility. Urological and bowel supplies are not included in the per diem for members living in an intermediate care facility for people with developmental disabilities (ICF/DD).
Indwelling Catheters and Insertion Trays
Indwelling catheters are covered for members who require catheters for continuous drainage. Most members can be served with one indwelling catheter per month. A second catheter may be allowed if the catheter is accidentally removed, malfunctions, or becomes obstructed or if the person has a medical history that requires the catheter to be replaced more than once per month. One insertion tray is covered per episode of indwelling catheter insertion. An insertion tray is not covered for use with an intermittent catheter. In rare situations, a person may require daily changes of indwelling catheters. Documentation must support the quantity dispensed.
Documentation of medical necessity (that is, recurrent encrustation, inability to pass a straight catheter or sensitivity to latex) is required for specialty indwelling catheters (A4340) or silicone catheters (A4312, A4315, A4344).
Intermittent Catheters
Intermittent catheters are covered for members who require catheters for immediate drainage. Most members can be served with 150 to 180 intermittent catheters per month. Up to 300 intermittent catheters without insertion supplies may be allowed if the member has a medical history that requires more than six episodes of catheterization daily. MHCP does not encourage the reuse of intermittent catheters. Reuse of intermittent catheters can cause infection. Intermittent catheters with sterile insertion supplies are covered if the person has a medical history that requires sterile, rather than clean, catheterization and documentation of medical necessity for sterile catheterization is maintained in the medical supplier’s files. The member’s living arrangement alone does not support the need for sterile catheterization. More than 300 intermittent catheters with insertion supplies per month require authorization. Documentation must support the quantity dispensed.
Drainage Collection Devices
Drainage collection devices are covered for members who require collection of urinary or fecal output. Most members can be served with one to two drainage bags or bottles per month. Additional drainage bags or bottles may be allowed if the person has a medical history that requires the bag to be replaced more frequently. Up to 10 units per month per combination of HCPCS codes A4357, A4358, A5102, and A5112 may be allowed if the member requires more frequent change of drainage collection devices. More than 10 drainage collection devices per month require authorization. Documentation must support the quantity dispensed.
Irrigation Supplies
Irrigation supplies are covered for members who require cleaning and irrigation for bowel management. Most members who require intermittent irrigation can be served with one irrigation tray or syringe per week. Up to 62 irrigation syringes or trays may be allowed per month if the person has a medical condition that requires more than daily irrigation with new syringes. Documentation must support the quantity dispensed. Supplies for intermittent irrigation of an indwelling catheter include either an irrigation tray or an irrigation syringe, and sterile water or saline.
Most members who require continuous irrigation can be served with one irrigation tubing set per day for up to two weeks. Up to 31 continuous days may be allowed if the person has persistent obstructions. Supplies for continuous irrigation include a three-way Foley catheter, irrigation tubing set and sterile water or saline.
Transanal Irrigation Systems and Catheters
Transanal irrigation is used for fecal incontinence, chronic constipation, or time-consuming bowel management procedures when other conservative bowel management alternatives have been tried and failed. Members must be at least three years or older and not have any contraindications for use of transanal irrigation systems.
Manual transanal irrigation systems (A4459) are covered if the following criteria are met:
Manual transanal irrigation systems currently require authorization through dates of service ending June 30, 2026. Effective July 1, 2026, authorization is only required for excess quantities. Most members can be served with one manual system per six months. MHCP covers one manual system per dispensing, up to four systems per year before authorization is required. HCPCS code A4459 represents one unit as one kit. Dispensing of manual systems includes the control unit, tube set, water container, case, and accessories.
Rectal catheters (A4453) are covered for use with transanal irrigation systems. Rectal catheters currently require authorization through dates of service ending June 30, 2026. Effective July 1, 2026, authorization is only required for excess quantities. HCPCS code A4453 represents one unit as one catheter. MHCP covers up to 31 catheters per month before authorization is required.
Electronic transanal irrigation systems (A4479) are covered with authorization if the following criteria are met:
Electronic transanal irrigation systems require authorization. Most members can be served with one electronic system per two years. HCPCS code A4479 represents one unit as one kit. Dispensing of electronic systems includes the control unit, cable, power adapter, tube sets, water container, case, and accessories.
Electronic transanal irrigation systems are noncovered for purposes of member or caregiver convenience. Documentation must establish that the member’s medical condition prevents them from using a manual system independently.
Transanal irrigation systems are contraindicated for any of the following:
Miscellaneous Urological and Bowel Supplies
Lubricant (A4332) is covered for members who require sterile insertion. Therapeutic agents for urinary catheter irrigation (A4321) with active ingredients and legend sterile saline solutions must be billed by a pharmacy as a drug.
Urinary catheter anchoring devices (A4333, A4334) are covered for members who use catheters.
Urethral inserts (A4336) are covered for members with urinary incontinence.
Adhesive tape (A4450, A4452) is only covered for urological and bowel supplies that do not have adhesive qualities. HCPCS codes A4450 and A4452 must be billed with modifier AU when furnished in conjunction with an ostomy, tracheostomy, or urological supply.
Enema tubes (A4457, A4458) are covered for members who use enemas. Replacement tubes are only covered when the original item no longer functions.
Replacement leg straps (A5113, A5114) are covered for members who use catheters when the original item no longer functions.
Pessaries (A4561, A4562, A4564) are covered for members with prolapsed bladders or uteruses.
Miscellaneous incontinence supplies (A4335) require authorization if the submitted combined charges are over $400. HCPCS code A4335 should only be used when an urological or bowel supply is not described by a more specific HCPCS code mentioned in this MHCP Provider Manual section. Documentation must clearly indicate member’s diagnosis, medical necessity, description of the item, and pricing information.
Urological and Bowel Supplies Table
Refer to the following Urological and Bowel Supplies Table and the Medical Supply Coverage Guide (PDF) for information on quantity limits for supplies.
Urological and Bowel Supplies Table
Category of Item | HCPCS Code(s) | Quantity Limit |
Indwelling catheters and insertion trays | A4310, A4311, A4312, A4313, A4314, A4315, A4316, A4338, A4340, A4342, A4344, A4346 | 1 unit per insertion, up to 31 units per month |
Intermittent catheters | A4295, A4296, A4297, A4351, A4352, A4353 | 200 units per dispensing, up to 300 units per month |
Irrigation trays | A4320 | 62 units per month |
Irrigation syringes | A4322 | 12 units per dispensing, up to 62 units per month |
Drainage collection devices | A4357, A4358, A5102, A5112 | 10 units per month per combination of A4357, A4358, A5102, and A5112 |
Manual transanal irrigation systems | A4459 | 1 unit per dispensing, up to 4 units per year |
Electronic transanal irrigation systems | A4479 | 1 unit per year |
Transanal irrigation catheters | A4453 | 31 units per month |
Medicare’s Medically Unlikely Edits (MUEs) apply to all HCPCS codes per date of service. These quantities represent MHCP’s monthly or annual quantity limits.
Noncovered Services
MHCP does not cover the following:
Authorization
Authorization is required for the following:
Submit authorization requests and required documentation to the Medical Review Agent.
Review the following categories of urological and bowel supplies for information on specific documentation required for each type of item.
Intermittent Catheters
Documentation must include an order from the physician stating how often the person must be catheterized and the medical justification for exceeding 300 catheters per month. Document must explain why clean catheterization techniques are not appropriate for the person.
Drainage Collection Devices
Documentation must include an order from the physician stating how often the collection bag or bottle must be changed and the medical justification for replacing the bag or bottle more than twice per week.
Billing
Providers are responsible to coordinate services. Refer to the Billing Policy Overview section of Provider Basics for general billing information.
Bill urological and bowel supplies using MN–ITS 837P. Refer to the Billing for Durable Medical Equipment, Medical Supplies, Prosthetics and Orthotics, and Augmentative Devices MN–ITS user manual for claim instructions.
Urological and bowel supplies are purchase items only.
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