New HCPCS Codes for Intermittent Catheters

Background:
On August 16, 2024, the Centers for Medicare & Medicaid Services (CMS) announced changes to the HCPCS code set for intermittent catheters. This includes the modification of two existing codes and the creation of three new codes to specifically identify products with hydrophilic coating technology. These changes acknowledge the clinical value of hydrophilic coatings and are intended to improve patient access and encourage continued innovation in urological care.

 To support the successful adoption of new and revised HCPCS codes related to intermittent catheters, we encourage taking the following steps:

1. Familiarize yourselves with the new HCPCS codes and updated code descriptions related to hydrophilic catheter technology: A4295, A4296, and A4297.
2. Coordinate with your billing and coding teams to ensure accurate documentation and coding practices that reflect these updates.
3. Advocate for appropriate reimbursement by working with your payer contacts to ensure coverage supports patient access to hydrophilic-coated catheter products.

The Pricing, Data Analysis and Coding (PDAC) contractor created a Hydrophilic Intermittent Urinary Catheter Crosswalk PDAC - Hydrophilic Intermittent Urinary Catheter Crosswalk

Additional information and resources on the New HCPCS Codes for Intermittent Catheters can be found on the American Association for Homecare website

CMS published prescription guidelines for hydrophilic catheters on July 17th that can be found here: Documentation Requirements for New Urological Supplies Codes

The following chart compares the current and new HCPCS codes:

Medicare coverage for intermittent catheters ^2,3

• Intermittent catheters (IC) are covered for Medicare beneficiaries who have a permanent impairment of urination. This is generally defined as a condition of long and indefinite duration.
• Medicare covers three types of intermittent catheters.

• Exact quantity of IC per month is determined by the clinician based on what is reasonable & necessary for each patient individual need
• Click here for the most up-to-date Urological Medicare Policy and Urological Medicare Article  

Medicare documentation for intermittent catheters ^2,3,4

Closed system (A4353): criteria information

• 3 new ICD-10 diagnosis codes were created to increase the level of specificity for reporting of patients with immunodeficiency related conditions. The use of these new diagnosis codes alone does not satisfy the Medicare medical necessity requirement for A4353.
• The medical record must reflect all relevant information to support the claim for A4353. The diagnosis must be well documented in the medical record with other supporting documentation that clearly meets the coverage criteria (1-5) under the Urological Medicare Policy.
• Click here for a printable resource of the DME MAC clarificat ion for immunosuppression and A4353

Medicare resources

• Medicare Urological Supplies Policy LCD - Urological Supplies (L33803) (cms.gov)
• Medicare Urological Supplies Article Article - Urological Supplies - Policy Article (A52521) (cms.gov)
• 2025 Medicare DME fee schedule DMEPOS Fee Schedule | CMS
• Documentation checklist for intermittent catheters:  Noridian Documentation Checklist for Urological Supplies and CGS Documentation Checklist for Urological Supplies: Intermittent Catheters
• Noridian clarification for A4353 under the immunosuppression criteria