No billing for catheter when insertion is charged

March 1, 2011

You cannot charge Medicare for the catheter when billing for a catheter insertion.

Q Can we bill Medicare patients for catheters as durable medical equipment (DME)? Specifically, can we use codes A4351, A5112, and A4338 when billed alone or with specific procedures such as 51701, 51702, and 51703? I cannot get a straight answer. I have been told, "Yes, with an advanced beneficiary notice (ABN) signed," "Yes, you don't have to an ABN signed," and, "No, you cannot charge Medicare patients for these." Please advise.

Let us repeat: This is not for a catheter you inserted that will be used at home; this is for a catheter given to the patient to use at home and for which there was no insertion performed or charged.