Urological and Bowel Supplies

Revised: April 25, 2025

· Overview

· Eligible Providers

· TPL and Medicare

· Eligible Members

· Covered Services

· Indwelling Catheters or Insertion Trays

· Intermittent Catheterization

· Drainage Collection Devices

· Irrigation Supplies

· Anal Irrigation System and Accessory Unit

· Authorization

· Excess Quantities of Intermittent Catheters

· Excess Quantities of Drainage Collection Devices

· Billing

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 providers may provide catheters and related supplies:

· Federally qualified health center

· Home health agencies

· Indian Health Services

· Medical suppliers

· Pharmacies

· Rural health clinic

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.

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-A4338, A4340, A4344, A4346, A4349, A4351-A4358, A4453, A4459, A5102, A5112

Indwelling Catheters or Insertion Trays
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 (such as recurrent encrustation, inability to pass a straight catheter or sensitivity to latex) is required for a specialty indwelling catheter (A4340) or a silicone catheter (A4312, A4315, A4344).

Intermittent Catheterization
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 person 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. Review the Authorization subsection for thresholds.

Drainage Collection Devices
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.

Exception: Due to the Centers for Medicare & Medicaid Services-required Medically Unlikely Edits (MUEs), A5102 is limited to one per month. Documentation must support the quantity dispensed. Review the Authorization subsection for thresholds.

Irrigation Supplies
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.

Authorization thresholds for urological supplies

HCPCS code(s)	Code category	Monthly threshold
A4353	Intermittent catheters with insertion supplies	300 units per month
A4357, A4358, A5112	Drainage collection devices	10 units in any combination per month
A4320, A4322	Irrigation supplies	62 units per month

Anal Irrigation System and Catheter (A4459 and A4453)
Anal 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.

The member must meet the following criteria:

· Has one of the following:

· Fecal incontinence

· Chronic constipation

· Bowel management methods or combination of methods requiring more than 30 minutes a day

· The following first-line bowel management methods have been prescribed and demonstrated failure:

· Dietary modification

· Medication

· Enema bag

· Physical therapies (pelvic floor stimulation, biofeedback, electrical stimulation)

For HCPCS code AA459, one unit is one kit and MHCP covers up to four units per year if medically necessary due to daily irrigation.

For HCPCS code A4453, one unit is one catheter. MHCP covers up to 31 units per month.

Authorization

Authorization is required for quantities of intermittent catheters with insertion supplies, or drainage collection systems exceeding limits.

Authorization is always required for HCPCS code A4459 and accessory units under HCPCS code A4453. Documentation must demonstrate failure and length of trial for first-line bowel management methods.

Submit authorization requests and required documentation to the Medical Review Agent.

Excess Quantities of Irrigation Supplies (A4320, A4322)

· For requests of more than 62 units per month, include documentation supporting the need for more than daily irrigation.

Excess Quantities of Anal Irrigation Systems (A4459)

· For requests more than two units per year, include documentation supporting the need for daily catheter use.

Excess Quantities of Anal Irrigation Catheters (A4453)

· For requests of more than 31 units per month, include documentation supporting the need for more than one catheter per day.

Excess Quantities of Intermittent Catheters (A4353)

· Authorization is required for billing more than 300 intermittent catheters with insertion supplies per month.

· 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 why clean catheterization techniques are not appropriate for the person.

Excess Quantities of Drainage Collection Devices (A4357, A4358, A5112)

· Authorization is required for billing more than 10 drainage bags or bottles per month.

· 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.

· Bill services approved through the authorization process on a separate claim from services not requiring authorization.

· HCPCS codes A4459 and A4453 require diagnosis, long description, and pricing attachment.

· If the member has Medicare, MHCP will pay the deductible or coinsurance on any units for which Medicare has made payment. Any units that Medicare denies payment for must meet MHCP quantity and authorization requirements. Authorization can be requested retroactively.