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.
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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.