Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesMedical And Surgical SuppliesHCPCS hcpcs-a4351-intermittent-urinary-catheter-straight-tip
    Ask Trek AI about this page

    HCPCS A4351: Intermittent Urinary Catheter, Straight Tip

    HCPCS Level II code A4351 identifies an intermittent urinary catheter, straight tip, supplied as a single catheter with or without coating (Teflon, silicone, silicone elastomer, etc.); this item represents disposable intermittent bladder catheterization supplies used for short-term catheterization, typically provided for urologic bladder management and supplied in outpatient settings, home health, or long-term care environments where patients perform intermittent self-catheterization or receive intermittent catheterization from a caregiver.

    For related coverage guidance, see recent payer policy updates: Diabetic Supplies, Radiofrequency Ablation for Thyroid Nodules, Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Idaho Only).

    Customize your policy alerts

    Sign up for hcpcs A4351 policy alerts

    Get alerted when payer policies referencing A4351 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    For HCPCS A4351, the BUCA average commercial benchmark sits at $1.60, providing a useful mid-market reference. Among individual commercial payers, Aetna and UnitedHealth Group exhibit relatively tight dispersion between the 25th and 75th percentiles: Aetna’s interquartile range is $0.70 ($1.00 − $0.30) and UnitedHealth Group’s is $0.60 ($1.70 − $1.10). Cigna’s interquartile spread is wider at $1.00 ($2.30 − $1.30), while Blue Cross Blue Shield shows the largest interquartile variation at $0.60? Wait recalculating: Blue Cross Blue Shield p75 $2.10 − p25 $1.50 = $0.60. Blue Cross Blue Shield and UnitedHealth Group are equally moderate in dispersion, and Cigna is the widest relative to its median.

    Beyond interquartile spreads, extreme values differ: Blue Cross Blue Shield and Cigna have higher upper percentiles (p90 $2.50 and $3.20 respectively), indicating farther high-end rates versus Aetna and UnitedHealth Group (p90 $1.50 and $2.50). The BUCA mean of $1.60 sits near the midpoint of the payer means, with Aetna lower at $0.90 and Blue Cross Blue Shield and Cigna higher at $1.80 each, reflecting a commercial market centered around $1.50–$1.80 for this code.

    Table of contents

    Progress1 / 8

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with neurogenic bladder or urinary retention who requires intermittent catheterization with a straight-tip catheter for bladder emptying. The patient may present in an outpatient urology clinic, primary care office, or receive training in a skilled nursing facility. A common scenario: a patient with spinal cord injury and diagnosis N31.9 (neuromuscular dysfunction of bladder) reports incomplete bladder emptying and recurrent urinary tract infections; the urology physician (208800000X) or a family nurse practitioner (363LF0000X) assesses post-void residual, determines intermittent catheterization is indicated, and supplies a series of sterile single-use straight-tip catheters billed as A4351. The workflow typically includes patient assessment, instruction on clean or sterile intermittent catheter technique, demonstration of first catheterization when indicated, and documentation of the medical necessity (diagnosis such as R33.9, N39.0, or R35.0). Supplies may be dispensed directly or via a contracted supplier; claims may include appropriate modifiers to indicate provider status, unexpected circumstances, or billing exceptions. Typical sites of service are outpatient clinic, home health visits, long-term care facility, or inpatient when intermittent catheterization is required during hospitalization. Service type: durable medical equipment/supply for intermittent urinary catheterization, single-use straight tip catheter, each.

    Related CPT Codes

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    74Modifier ‑74 indicates an outpatient hospital or ASC procedure that was discontinued after anesthesia was administered and after the procedure had begun. Use this modifier when anesthesia (local,…- Use modifier -74 when a procedure in an outpatient hospital or ASC setting is terminated after anesthesia has been administered and after the procedure has commenced (for example, after incision,…
    P3Modifier P3 denotes that the anesthesia patient has severe systemic disease (ASA III). It applies only to anesthesia CPT codes (00100–01999) and must be appended by the anesthesia provider with…- Applies only to anesthesia procedure codes (CPT 00100–01999) and should be appended by the anesthesia provider when the patient meets the definition of "severe systemic disease" (CPT/AAPC P3;…
    P2Modifier P2 denotes an ASA Physical Status II — a patient with mild systemic disease. Per AMA/AAPC, examples include well-controlled hypertension or diabetes, mild obesity (BMI 30–40), current smoker…- When to use: Append modifier -P2 to anesthesia CPT codes (00100–01999) when the anesthesia provider documents the patient has mild systemic disease (ASA Physical Status II) — for example…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208800000X
    363LF0000X
    363LA2200X
    2086S0120X
    3104A0625X
    207QA0401X
    283X00000X
    2080C0008X

    Related Payer Policy Updates

    Specialty: Endocrinology1 / 3

    10 rows

    PolicyPayerEffective Date
    Diabetic SuppliesCigna2026-10-15
    Radiofrequency Ablation for Thyroid NodulesCigna2026-10-15
    Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Idaho Only)UnitedHealthcare2026-10-01
    Tzield (teplizumab-mzwv) CoverageUnitedHealthcare2026-10-01
    Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Indiana Only)UnitedHealthcare2026-10-01
    Medical Necessity Guidelines Insulin PumpsMass General Brigham Health Plan2026-10-01
    Medical Necessity Guidelines: Continuous Glucose MonitorsMass General Brigham Health Plan2026-10-01
    Continuous Glucose MonitoringAmbetter Nevada2026-10-01
    Salivary Hormone TestingOscar Health2026-10-01
    Parathyroid Hormone, Phosphorus, Calcium, and Magnesium TestingOscar Health2026-10-01

    Related Codes

    HCPCS-A4206-STERILE-SYRINGE-1CC-NEEDLE

    HCPCS A4206: Syringe with Needle, 1 cc or Less, Sterile

    HCPCS-A4207-STERILE-2CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4207: Syringe with Needle, Sterile 2 cc

    HCPCS-A4208-STERILE-3CC-SYRINGE-WITH-NEEDLE

    HCPCS Level II A4208: Syringe with Needle, Sterile 3 cc

    HCPCS-A4209-STERILE-SYRINGE-WITH-NEEDLE-5CC-OR-GREATER

    HCPCS Level II A4209: Syringe with Needle, Sterile 5 cc or Greater

    HCPCS-A4210-NEEDLE-FREE-INJECTION-DEVICE

    HCPCS Level II A4210: Needle-free Injection Device, Each

    HCPCS-A4211-SUPPLIES-SELF-ADMINISTERED-INJECTIONS

    HCPCS Level II A4211: Supplies for Self-Administered Injections

    HCPCS-A4212-NON-CORING-NEEDLE-STYLET-CATHETER-ACCESS-SUPPLY

    HCPCS Level II A4212: Non-coring Needle or Stylet with/without Catheter

    HCPCS-A4213-STERILE-SYRINGE-20CC-OR-GREATER

    HCPCS Level II A4213: Syringe, Sterile, 20 cc or Greater, Each

    HCPCS-A4215-STERILE-NEEDLE-SINGLE-EACH

    HCPCS Level II A4215: Needle, Sterile, Any Size

    HCPCS-A4216-STERILE-DILUENT-FLUSH-10ML

    HCPCS Level II A4216: Sterile Diluent/Flush, 10 ml

    Showing 1–10 of 633

    • More pages

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    CPT Code
    Description
    Relationship to This Procedure
    A4352Intermittent urinary catheter, coude (curved) tipAlternative intermittent catheter type; used when a curved tip is clinically required instead of straight-tip A4351.
    A4338Indwelling catheter; Foley type, two-way latexRepresents an indwelling catheter option when intermittent catheterization is not appropriate; may be chosen before or after assessment.
    A4310Insertion tray without drainage bag and catheterSupplies for catheter insertion; may be billed when a tray is used during catheter placement.
    A4311Insertion tray with drainage bag and catheterUsed when an insertion tray that includes a drainage bag and catheter is supplied for placement.
    A4331Extension drainage tubing, any typeAccessory supply that can be used with indwelling catheters or drainage systems in the same episode of care.