Hydrophilic Intermittent Urinary Catheter Crosswalk

On October 7, 2024, the Centers for Medicare & Medicaid Services (CMS) published its Final HCPCS Coding Decisions for the First Biannual Coding Cycle for 2024. Therein CMS created three new Healthcare Common Procedure Coding System (HCPCS) level II codes to individually describe intermittent urinary catheters with hydrophilic coatings. For billing purposes, the effective date of these new HCPCS codes has been set to January 1, 2026, to allow sufficient time for implementation of necessary program coding changes.
 

The Pricing, Data Analysis and Coding (PDAC) contractor conducts code verification review (CVR) of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) to assists manufacturers and distributors with proper coding for billing to the Durable Medical Equipment Medicare Administrative Contractors (DME MACs).  As a resource, the PDAC publishes all code verified product to its Product Classification List (PCL). 

In response to the creation of the above HCPCS codes, PDAC is initiating a secondary review of all intermittent urinary catheters currently assigned to HCPCS A4351, A4352 and A4353 on the PCL. Starting January 2025, PDAC will begin contacting manufacturers and distributors of these urinary catheters to establish lines of communication for this effort. Manufacturers and distributors with affected product information on the PCL are encouraged to contact the PDAC via the Contact Us form to specify a primary point of contact (POC) no later than March 31, 2025. Manufacturers and distributors for which no contact can be established will not have their product information updated on the PCL effective January 1, 2026, and may have their product information code end dated if determined obsolete. 

PDAC will work with POCs for each manufacturer/distributor over the course of 2025 to assess whether their listed products qualify for one of the new hydrophilic intermittent urinary catheter HCPCS codes. All applicable product information identified for a code change will be captured and updated periodically on the Hydrophilic Intermittent Urinary Catheter Crosswalk located at the bottom of this page. Product listed on this document will be cross walked to the appropriate HCPCS code on the PCL effective January 1, 2026. Manufacturers and distributors should check the list periodically for updates and utilize the list as a reference to educate suppliers on pending billing code changes. 

Submission of a new CVR application is required if changes to existing PCL product information, such as manufacturer/distributor name, product name, or model number are necessary or requested.

All manufacturers and distributors wanting to have new product code verified for HCPCS A4351, A4352 and A4353 and placed on the PCL effective January 1, 2026, should submit their products to PDAC before October 31, 2025. These products will be coded to existing intermittent urinary catheter HCPCS codes and placed on the PCL for the interim before being cross walked with all other applicable product information to a new HCPCS code on January 1, 2026. All CVR applications received by PDAC after October 31, 2025, will have codes assigned after January 1, 2026. 

IMPORTANT: PDAC is unable to back date code decisions to January 1, 2026.

Correct coding is an essential element for correct claims processing and payment. The PDAC contractor maintains a variety of resources to assist suppliers in determining the appropriate code for Medicare billing. For questions about correct coding, contact the 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 Us button at the top of the PDAC website for email, FAX, or postal mail information.

Hydrophilic Intermittent Urinary Catheter Crosswalk - updated 12/31/2024