Ringing in the new year will include significant changes to Medicare policies and coding for urinary catheters.
The HCPCS code changes were published jointly by the DME MAC contractors and Medicare’s Pricing, Data Analysis and Coding contractor (PDAC) on Dec. 18, with a reminder that the changes are effective for claims with dates of service on or after Jan. 1, 2026.
The new urological supplies codes are as follows:
A4295: Intermittent urinary catheter; straight tip, hydrophilic coating, each
A4296: Intermittent urinary catheter; coude (curved) tip, hydrophilic coding, each
A4297: Intermittent urinary catheter; hydrophilic coating with insertion supplies
CMS also made changes to the current A4351 and A4352 codes. On Jan. 1, the narrative for A4351 becomes “Intermittent urinary catheter; straight tip, with or without coating (Teflon, silicone or silicone elastomer, etc.), each.” The narrative for A4352 is changing to “Intermittent urinary catheter; coude (curved) tip, with or without coating (Teflon, silicone or silicone elastomeric, etc.), each.”
In July, CGS Administrators, the DME MAC for jurisdictions B and C, noted that Medicare beneficiaries with existing standard written orders (SWOs) that list HCPCS codes A4351, A4352 or A4353 will be required to obtain new SWOs that “can list the new HCPCS code A4295, A4296 or A4297, as appropriate, or the description can be a general description (e.g., hydrophilic catheter) or a brand name/model number.”
CGS added that Medicare patients whose current SWOs contain a general description, such as hydrophilic catheter, are not required to secure new SWOs, but that suppliers “must start utilizing the new HCPCS codes A4295, A4296 and A4297 when billing claims for dates of service on or after Jan. 1, 2026.”
