PDAC Coding Guidelines for Hydrophilic Intermittent Urinary Catheters

The information presented in this article comes from the current coding guidelines found in the Urological Supplies Policy Article (A52521) and assessment of products that have been submitted to the PDAC for Code Verification Review.

Effective for dates of service on or after January 1, 2026, the Centers for Medicare and Medicaid Services (CMS) created three (3) new HCPCS codes for hydrophilic intermittent urinary catheters:

1. HCPCS Level II code A4295, “Intermittent urinary catheter; straight tip, hydrophilic coating, each”
2. HCPCS Level II code A4296, “Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each”
3. HCPCS Level II code A4297, “Intermittent urinary catheter; hydrophilic coating, with insertion supplies”

 With respect to hydrophilic intermittent urinary catheters: 

• A hydrophilic catheter self-lubricates when activated with water or 0.9% sterile saline without the use of a separate lubricating gel. 

This article’s objective is to guide manufacturers and distributors in providing the necessary information to the Pricing, Data Analysis, and Coding (PDAC) contractor for the correct coding of hydrophilic intermittent urinary catheters.

Requirement 1:  The code verification review (CVR) application must clearly identify the method by which the intrinsic hydrophilic properties of the urinary catheter are achieved so that the catheter’s surface can bind water to make a uniform lubricious layer, and the lubricity can be easily restored by immersing the device in water. This description should identify the specific technological approach that creates this hydrophilic functionality. 

Requirement 2: To facilitate the code review process, applicants submitting for a hydrophilic intermittent urinary catheter HCPCS code must provide a sample of the item, including instructions for its preparation and use, at the time of submission of the CVR application.

Finally, the PDAC would like to remind submitters that in addition to the completed application and required documentation, please provide any relevant information that further validates the requested HCPCS code in your submission. The PDAC’s review and code decision rely on the information provided by the applicant.

For questions about correct coding or products not listed on the DMECS Product Classification List, 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 Us button at the top of the PDAC website for email, FAX, or postal mail information.