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	Urological Rules and Limits

	Having trouble finding the Urological Supplies you need or finding a supplier that will accept Medicare Assignment? Better Living Now is here to help you. We carry all your supplies and we work with you towards providing your supplies under Medicare assignment through our Preferred Program. If you are covered under Medicare, many of your medically necessary supplies and related products may be covered! To get started enroll today or print out an Urological Supplies Order Form, bring it to your doctor and mail your or fax your order to us. It is that easy! How The Program Works

Urological Supplies Allowable Amounts

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Urological Supplies Allowable Amounts - Effective 02/04/2011

Product Description	Quantity Limitations	BLN Assignment?
A4217 STERILE WATER/SALINE, 500 ML
A4310 INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER (ACCESSORIES ONLY)
A4311 INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR HYDROPHILIC, ETC.)
A4312 INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE
A4313 INSERTION TRAY WITHOUT DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, THREE-WAY, FOR CONTINUOUS IRRIGATION
A4314 INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR HYDROPHILIC, ETC.)
A4315 INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE
A4316 INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER, FOLEY TYPE, THREE-WAY, FOR CONTINUOUS IRRIGATION
A4320 IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE
A4321 THERAPEUTIC AGENT FOR URINARY CATHETER IRRIGATION
A4322 IRRIGATION SYRINGE, BULB OR PISTON, EACH
A4326 MALE EXTERNAL CATHETER WITH INTEGRAL COLLECTION CHAMBER, ANY TYPE, EACH
A4327 FEMALE EXTERNAL URINARY COLLECTION DEVICE; MEATAL CUP, EACH
A4328 FEMALE EXTERNAL URINARY COLLECTION DEVICE; POUCH, EACH
A4331 EXTENSION DRAINAGE TUBING, ANY TYPE, ANY LENGTH, WITH CONNECTOR/ADAPTOR, FOR USE WITH URINARY LEG BAG OR UROSTOMY POUCH, EACH
A4332 LUBRICANT, INDIVIDUAL STERILE PACKET, EACH
A4333 URINARY CATHETER ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT, EACH
A4334 URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH
A4335 INCONTINENCE SUPPLY; MISCELLANEOUS
A4336 INCONTINENCE SUPPLY, URETHRAL INSERT, ANY TYPE, EACH
A4338 INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH
A4340 INDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE, MUSHROOM, WING, ETC.), EACH
A4344 INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH
A4346 INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUS IRRIGATION, EACH
A4349 MALE EXTERNAL CATHETER, WITH OR WITHOUT ADHESIVE, DISPOSABLE, EACH
A4351 INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH
A4352 INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMERIC, OR HYDROPHILIC, ETC.), EACH
A4353 INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES
A4354 INSERTION TRAY WITH DRAINAGE BAG BUT WITHOUT CATHETER
A4355 IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATION THROUGH A THREE-WAY INDWELLING FOLEY CATHETER, EACH
A4356 EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE (NOT TO BE USED FOR CATHETER CLAMP), EACH
A4357 BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUT ANTI-REFLUX DEVICE, WITH OR WITHOUT TUBE, EACH
A4358 URINARY DRAINAGE BAG, LEG OR ABDOMEN, VINYL, WITH OR WITHOUT TUBE, WITH STRAPS, EACH
A4360 DISPOSABLE EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE, WITH PAD AND/OR POUCH, EACH
A4402 LUBRICANT, PER OUNCE
A4450 TAPE, NON-WATERPROOF, PER 18 SQUARE INCHES
A4452 TAPE, WATERPROOF, PER 18 SQUARE INCHES
A4455 ADHESIVE REMOVER OR SOLVENT (FOR TAPE, CEMENT OR OTHER ADHESIVE), PER OUNCE
A4456 ADHESIVE REMOVER, WIPES, ANY TYPE, EACH
A4520 INCONTINENCE GARMENT, ANY TYPE, (E.G. BRIEF, DIAPER), EACH
A4554 DISPOSABLE UNDERPADS, ALL SIZES
A5102 BEDSIDE DRAINAGE BOTTLE WITH OR WITHOUT TUBING, RIGID OR EXPANDABLE, EACH
A5105 URINARY SUSPENSORY WITH LEG BAG, WITH OR WITHOUT TUBE, EACH
A5112 URINARY DRAINAGE BAG, LEG OR ABDOMEN, LATEX, WITH OR WITHOUT TUBE, WITH STRAPS, EACH
A5113 LEG STRAP; LATEX, REPLACEMENT ONLY, PER SET
A5114 LEG STRAP; FOAM OR FABRIC, REPLACEMENT ONLY, PER SET
A5131 APPLIANCE CLEANER, INCONTINENCE AND OSTOMY APPLIANCES, PER 16 OZ.
A5200 PERCUTANEOUS CATHETER/TUBE ANCHORING DEVICE, ADHESIVE SKIN ATTACHMENT
A9270 NON-COVERED ITEM OR SERVICE

Notes - none

ICD-9 Codes that Support Medical Necessity

	Product Description		Quantity Limitations		BLN Assignment?
	A4336 - 625.6 STRESS INCONTINENCE FEMALE

Notes - none

	Urological Supplies Guidelines

	General Information For more information on local coverage determination Local Coverage Determination (LCD) for Urological Supplies Documentations Requirements Section 1833(e) of the Social Security Act precludes payment to any provider of services unless "there has been furnished such information as may be necessary in order to determine the amounts due such provider." It is expected that the patient's medical records will reflect the need for the care provided. The patient's medical records include the physician's office records, hospital records, nursing home records, home health agency records, records from other healthcare professionals and test reports. This documentation must be available upon request. An order for each item billed must be signed and dated by the treating physician, kept on file by the supplier, and made available upon request. Items billed before a signed and dated order has been received by the supplier must be submitted with an EY modifier added to each affected HCPCS code. The order must include the type of supplies ordered and the approximate quantity to be used per unit of time. KX and GY MODIFIERS: Suppliers must add a KX modifier to a code only if the order indicates the patient has permanent urinary incontinence or urinary retention, and if the item is a catheter, an external urinary collection device, or a supply used with one of these items. If all the criteria in the related Policy Article are not met, the GY modifier must be added to the code. Claims lines billed without a KX or GY modifier will be rejected as missing information. Refer to the Supplier Manual for more information on documentation requirements. Refills For more information on local coverage determination Local Coverage Determination (LCD) for Urologicall Supplies