Documentation Requirements for New Urological Supplies Codes - JD DME

Joint DME MAC Publication
Posted July 17, 2025

Effective for dates of service on or after January 1, 2026, CMS created three new HCPCS codes for hydrophilic catheters:

Prior to the creation of the new HCPCS codes, hydrophilic catheters were coded with HCPCS codes  A4351 (INTERMITTENT URINARY CATHETER; STRAIGHT TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH), A4352 (INTERMITTENT URINARY CATHETER; COUDE (CURVED) TIP, WITH OR WITHOUT COATING (TEFLON, SILICONE, SILICONE ELASTOMERIC, OR HYDROPHILIC, ETC.), EACH), or A4353 (INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES). Suppliers must discontinue use of A4351, A4352, and A4353 and utilize the new HCPCS codes A4295, A4296, and A4297 on claims for hydrophilic catheters with dates of service on or after January 1, 2026.

Questions have arisen from the stakeholder community about standard written orders (SWOs) for Medicare beneficiaries who utilize hydrophilic catheters coded with HCPCS codes A4351, A4352, or A4353 for dates of service prior to January 1, 2026. Two common questions have been posed:

Question 1: Will beneficiaries with existing SWOs that specifically list HCPCS codes A4351, A4352, or A4353 be required to get new SWOs?
Response: Yes. A new SWO is required, based on the New Order Requirements in the Standard Documentation Requirements for All Claims Submitted to DME MACs Policy Article (A55426). The new order 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.

Question 2:  Will beneficiaries with existing SWOs that list a general description (e.g. "hydrophilic catheter") be required to get new SWOs?
Response: No. Since the beneficiary’s current SWO verbiage is descriptive of the new hydrophilic catheter HCPCS code(s), no new order is required. Suppliers must start utilizing the new HCPCS codes A4295, A4296, and A4297 when billing claims for dates of service on or after January 1, 2026.

For questions about correct coding, contact the Pricing, Data Analysis and Coding (PDAC) HCPCS Helpline at (877) 735-1326 during the hours of 9:30 a.m. to 5:00 p.m. ET, Monday through Friday. You may also visit the PDAC website to chat with a representative or select the Contact Usbutton at the top of the PDAC website for email, FAX, or postal mail information.

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