HCPCS Level II › A codes A4321 Cath therapeutic irrig agentTherapeutic agent for urinary catheter irrigation
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction Outpatient hospital: max 1 units per day (clinical), rationale: Code Descriptor / CPT Instruction DME supplier: max 0 units per day (clinical), rationale: Published Contractor Policy Medicare pricing for A4321 DMEPOS fee schedule, July 2026 (DME26-C) no modifier, ostomy, tracheostomy and urological (OS): no amount on file (priced by the DME MAC) Physician Fee Schedule (CY 2026, RVU26D) Status X: statutory exclusion, not paid under the PFS.
Payer policies and prior authorization for A4321 Payer coverage policies that name A4321 A4321 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Urological Supplies (0533) not covered Jul 30, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in MA, OH.
MD: $15.33 (dme), effective Apr 1, 2026 TX: $8.28 (dmepos_tos_9_e_j_l_and_r, Home Health Dme, non-facility), effective Jan 1, 2015 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026 From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.