Catheter 101: No-Touch Catheters & Closed Catheter Systems

No-touch or closed catheter systems are the Ferraris of the intermittent catheter world. These catheters are distinguishable by two factors: they’re typically covered from tip to funnel with plastic, and they’re very, very expensive, being reimbursed under a completely different reimbursement code (A4353) than "standard" catheters.

It can be hard to secure coverage for these catheters – in 2021, no-touch/closed catheter systems accounted for ~5% of all catheters covered by Medicare (1)! These catheters cost roughly 4x as much as standard catheters. To get insurance coverage for these catheters from Medicare, one of the following conditions have to be met and supported with documentation from your clinician:

• The beneficiary resides in a nursing facility,
• The beneficiary is immunosuppressed, for example (not all-inclusive):
  • on a regimen of immunosuppressive drugs post-transplant,
  • on cancer chemotherapy,
  • has AIDS,
  • has a drug-induced state such as chronic oral corticosteroid use;
  • in addition, high-level spinal cord injury patients (T3 and higher) will be considered for coverage when conducting medical reviews.
• The beneficiary has radiologically documented vesico-ureteral reflux while on a program of intermittent catheterization,
• The beneficiary is a spinal cord injured female with neurogenic bladder who is pregnant (for duration of pregnancy only),
• The beneficiary has had distinct, recurrent urinary tract infections, while on a program of sterile intermittent catheterization with A4351/A4352 and sterile lubricant A4332, twice within the 12-month prior to the initiation of sterile intermittent catheter kits.

You get what you and your insurance pay for though, as these catheters have been demonstrated to reduce UTI incidence by between 30%(2) - 44.5%(3) in academic literature.

Both no-touch and closed catheter systems usually (but not always!) come with features like an introducer tip or an insertion sleeve, both of which help the catheter avoid contact with difficult-to-clean regions of your body like the urethral opening or the hands, respectively.

Studies have shown that features like this help to reduce the amount of germs that are transferred to the catheter by 100x(4). Without these features, there is a possibility that germs transferred to the catheter then get transferred to the bladder when the catheter is fully inserted.

Closed catheter systems, unlike no-touch catheters, usually come with an integrated urine bag that can collect your urine and be used to drain it later if you’re not near a toilet when you need to catheterize – which is also a reason why wheelchair users swear by them. It can be a real struggle to find an accessible restroom when you’re out and about.