CMS proposes coding changes for intermittent urinary catheters 

WASHINGTON – CMS has 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. 

The agency stated that it does not see a claims processing need to discontinue or modify existing HCPCS code A4353, “Intermittent urinary catheter, with insertion supplies.” 

“CMS believes that clinical evidence and current payer policies would support HCPCS Level II codes to identify hydrophilic coatings, particularly as there is evidence that, for some patients, hydrophilic catheters may reduce the incidence of UTIs,” the agency stated in an agenda for a  May 28 public meeting. 

The agency mapped out the new codes as follows: 

1. Establish a new HCPCS Level II code AXXXX, “Intermittent urinary catheter; straight tip, with or without coating (Teflon, silicone, silicone elastomer, etc.), each” 

2. Establish a new HCPCS Level II code AXXXX, “Intermittent urinary catheter; coude (curved) tip, with or without coating (Teflon, silicone, silicone elastomeric, etc.), each” 

3. Establish a new HCPCS Level II code AXXXX, “Intermittent urinary catheter; straight tip, hydrophilic coating, each” 

4. Establish a new HCPCS Level II code AXXXX, “Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each” 

5. Establish a new HCPCS Level II code AXXXX, Intermittent urinary catheter; hydrophilic coating, with insertion supplies” 

The agency says it will follow its continuity of pricing regulations for this preliminary payment determination. 

AAHomecare submitted the request to expand the list of codes for intermittent urinary catheters based on an analysis and review by the Intermittent Catheter Coding Reform Coalition (RCCRC), a coalition of manufacturers. Their initial request included 19 new codes to further distinguish the functionalities of straight tip intermittent urinary catheters, curved tip intermittent urinary catheters and insertion supplies. 

“Pending further feedback and final determination, CMS anticipates the proposed changes to take effect on Jan. 1, 2026,” the association stated in a bulletin. “ICCRC is pleased that CMS has established new HCPCS codes for intermittent catheters, recognizing hydrophilic features separately from other catchers. AAHomecare, in collaboration with ICCRC, will be commenting on the proposed changes.”   

For more information on the proposed changes, read the full meeting agenda here.