Catheter proposal is ‘huge step forward’

WASHINGTON – CMS’s plan to “explode the codes” for intermittent urinary catheters will better reflect available technologies, says Cara Bachenheimer, who leads the Government Affairs Practice of Brown & Fortunato. 

CMS in May proposed discontinuing two existing HCPCS codes for intermittent urinary catheters, A4351 and A4352, and establishing five new codes, in response to a request from AAHomecare and its manufacturer members, who comprise the Intermittent Catheter Coding Reform Coalition. 

“For years, there’s only been three HCPCS codes for about 1,300 products and these codes were created decades ago,” said Bachenheimer, who is representing AAHomecare on the issue. “There’s been huge advancements in technology, particularly with the hydrophilic coatings.” 

CMS is expected to finalize its coding decisions early this fall. Once it does, the DME MACs will have to revise local coverage determinations and there will need to be educational outreach for the clinical and supplier communities. 

Stakeholders, who have been pressing for coding changes for about two years, had initially asked for 16 codes, so while the proposal isn’t as expansive as they had hoped, it’s still a “huge step forward,” says Bachenheimer. 

As well as better reflecting the different technologies, the new codes will improve patient access and provide better care, she said. 

“Prescribers often just prescribe by HCPCS code and given that there’s such a wide variety of features and functionalities this is a way for the prescriber to better ensure the patient gets exactly what they want,” says Bachenheimer.  

It will also go a long way toward solving a Catch-22 where CMS wanted the clinical benefits of various products, but with everything “jumbled together,” it was difficult for stakeholders to make their case, says Bachenheimer. 

CMS has suggested an implementation date of January 2026, but stakeholders would like to see that moved forward. 

“We think around July 2025 is a reasonable timeframe for everybody to do what needs to be done,” said Bachenheimer.