Countdown to coding change: CMS to update HCPCS for hydrophilic caths

YARMOUTH, Maine – New HCPCS coding changes for intermittent catheters take effect Jan. 1, 2026, and there are steps providers can take now to make sure they are ready, says Kathryn Vaughn, director of market access for Coloplast. 

CMS will modify two existing codes (A4351& A4352) and add three new codes (A4295, A4296 & A4297) to differentiate catheters with a hydrophilic coating. 

Vaughn said providers can take the following steps to prepare for implementation: 

• Educate your staff regarding the new codes and steps to preserve hydrophilic intermittent catheter access. 
• Update billing and intake systems. 
• Review and ensure compliance with prescription guidance from the DME MACs. 
• Communicate with referral sources on the need for updated hydrophilic intermittent catheter prescriptions. 
• Educate payers to minimize billing challenges and other administrative burdens associated with the new HCPCS codes. 

Vaughn also provided HME News with background on the changes and additional information on implementation. 

HME News: What is the background of the upcoming changes?  

Kathryn Vaughn: Most catheters that have become available recently use hydrophilic coatings, which have certain clinical and ease-of-use benefits versus other coating types. The new billing codes differentiate between these hydrophilic catheters and those without a hydrophilic coating. While this is a positive change – as it recognizes hydrophilic coating innovation – it requires catheter users, their DME providers and clinicians to take steps to ensure their prescription supports them in continuing to receive the catheter that works for them.  

HME: Does this change reimbursement?  

Vaughn: CMS is bound by continuity of pricing regulation (§ 414.236 (b) ‘Continuity of pricing when HCPCS codes are divided or combined’) and thus Medicare reimbursement rates for new hydrophilic codes are the same as the existing codes. 

HME: Does this change coverage?  

Vaughn: There are no anticipated changes to product coverage criteria. CMS has announced a proposed local coverage determination (LCD).  

HME: How do we know which catheters are hydrophilic?  

Vaughn: The Pricing, Data Analysis and Coding (PDAC) published a crosswalk for hydrophilic catheters, available on the PDAC website. The crosswalk identifies products by manufacturer/model number and maps each catheter to the new hydrophilic HCPCS codes. DME providers should regularly check the crosswalk for the latest updates.  

HME: What is the guidance from CMS on prescriptions?  

Vaughn: Patients utilizing hydrophilic catheters will need to get a new prescription from their provider to continue receiving these catheters, per a joint DME MAC publication (CGS and Noridian) from July 2025. The publication stated: A new prescription is required for a hydrophilic catheter if the existing prescription includes a HCPCS code (A4351, A4352 or A4353). The new order can list the new HCPCS codes (A4295, A4296 or A4297), a general description (e.g., hydrophilic catheter), or a brand name/model. A new prescription is not required if the existing prescription is a general description (e.g., hydrophilic catheter), or brand/model number.  

HME: Can we start updating prescriptions now?  

Vaughn: Yes, by starting to update prescriptions now, DME providers will be prepared for the implementation, minimizing access challenges for new and existing hydrophilic catheter users. 

Related: Cath changes: Stakeholders anxious about next steps & Catheter proposal is ‘huge step forward’