Summary & Overview
HCPCS Level II A4316: Three-Way Foley Insertion Tray for Continuous Irrigation
HCPCS Level II code A4316 designates an insertion tray that includes a drainage bag and a three-way indwelling Foley catheter intended for continuous bladder irrigation. This code identifies a bundled supply and insertion service used primarily in surgical and acute care settings when continuous irrigation is required, such as after urologic procedures or to manage gross hematuria.
Key national payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Coverage and reimbursement policies for A4316 vary by payer and setting, with distinctions commonly drawn between inpatient, outpatient, and ambulatory procedure environments.
Readers will find clinical context for the device and common sites of use, a summary of which major payers cover the code, and an overview of the types of benchmarks and policy elements typically evaluated for HCPCS supply codes (coverage indications, site-of-service considerations, and billing practice notes). Data not available in the input includes payer-specific rate tables, associated ICD-10 diagnosis mappings, and related billing codes. The publication provides concise reference material to support coding, billing, and policy review for facilities and billing professionals working with three-way Foley catheter insertion trays.
Billing Code Overview
HCPCS Level II code A4316 describes an insertion tray with drainage bag with indwelling catheter, Foley type, three-way, for continuous irrigation. This supply package is used to place and maintain a three-way indwelling urinary catheter designed to allow continuous bladder irrigation.
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Service type: Insertion and supply of a three-way Foley catheter system for continuous irrigation
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Typical site of service: Hospital inpatient or outpatient settings, surgical suites, and specialized procedural treatment areas where continuous bladder irrigation is performed
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult hospitalized inpatient or seen in an ambulatory surgical center requiring placement of a three-way indwelling Foley catheter with an attached insertion tray and drainage bag for continuous bladder irrigation (CBI). Common clinical scenarios include postoperative management after transurethral resection of the prostate (TURP), transurethral resection of bladder tumor (TURBT), or other urologic procedures with anticipated hematuria; management of gross hematuria requiring continuous irrigation to prevent clot formation; or bedside insertion for bladder irrigation in patients with significant bleeding or clot retention. The workflow begins with urology or trained nursing staff obtaining informed consent and reviewing anticoagulation status, assembling the sterile insertion tray with the three-way Foley and drainage bag (A4316 describes the insertion tray with drainage bag for continuous irrigation). Aseptic insertion is performed, catheter position and balloon inflation are confirmed, continuous irrigation is initiated and tubing secured, and urine output and irrigation return are monitored. Documentation includes indication, catheter size and type, sterile technique, irrigation solution and rate, patient tolerance, and plan for duration of irrigation and catheter removal or exchange.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default electronic submission indicator |