The healthcare industry keeps on reminding us that the only constant is change, and this time, that change is coming in the form of a major HCPCS update.
The beginning of 2026 brings one of the most vital coding revisions in recent years for DME suppliers and practices who bill intermittent urinary catheters. The new year is introducing three new HCPCS codes A4295, A4296, and A4297, as CMS has officially announced. These new codes are supposed to replace the long-standing catheter codes A4351, A4352, and A4353.
The code keeps on updating with time due to market or technology developments, and stakeholder requests. But it carries meaningful implications for your revenue cycle, especially if your practice depends highly on catheter claims within your DME billing workflow.
From billing accuracy, updated order requirements, payer guidelines,documentation expectations, and long-term compliance, this shift is going to affect all. Let’s dive into this blog and understand what changes are on the way as of January 1, 2026, how can you be preparing early to prevent administrative disruption, claim denials, and cash flow delays.
Why CMS Introduced New Codes for Hydrophilic Catheters?
Undoubtedly, changes to long-standing HCPCS codes never happen without reason. In this case as well, several key factors came together to drive the introduction of these new hydrophilic catheter codes.
1. Older codes were too broad
For many years the hydrophilic catheters have been billed under broad, and non-specific HCPCS descriptions that grouped multiple catheter types together. For the payers it was difficult to distinguish between coated catheters, hydrophilic technology, or catheter kits that included insertion supplies. Why was it a concern? Because, this created plenty of reimbursement inconsistencies and confusion in medical billing workflows.
Hence, to better the clarity and accuracy, CMS has created three new HCPCS codes which are going to be effective from January 1, 2026:
- A4295: A straight-tip intermittent urinary catheter that includes a hydrophilic coating, billed per unit.
- A4296: A curved (coudé) tip intermittent urinary catheter featuring a hydrophilic coating, billed per unit.
- A4297: A hydrophilic-coated intermittent urinary catheter that comes packaged with the necessary insertion supplies, billed per unit.
Prior to this update, hydrophilic catheters were billed under broader codes that included multiple coating types:
- A4351: A straight-tip intermittent catheter, supplied either coated or uncoated.
- A4352: A coudé (curved-tip) intermittent catheter, available with or without a coating.
- A4353: An intermittent catheter kit that includes the required insertion supplies.
2. Fast growth in hydrophilic catheter usage
In last ten years, the hydrophilic technology saw a huge shift and became:
- more widely prescribed
- clinically preferred due to lower UTI risk
- more expensive to manufacture
So, CMS needed a way to accurately categorize and reimburse these products separately.
3. CMS needed clearer coding for pricing & fee schedule setting
Without separate codes, CMS was unable to track utilization accurately, set distinct reimbursement rates, and analyze cost trends. Moreover, the Hydrophilic catheters cost more to manufacture, still they were paired under the same reimbursement category as low-cost uncoated catheters. This created payment distortion.
Why Does This Change Matters for Your Practice?
Each and every HCPCS update influences how supplies are billed, documented, and reviewed, but this update is major and it is going to affect a high-volume product category.
Since, hydrophilic catheters are one of the most commonly dispensed DME supplies, it means even minor coding mistakes can lead to huge claim rejections, delayed payments, and increased administrative load.
It will not be a surprise that the practices that overlook these changes risk reimbursement interruptions. Not because services weren’t given correctly, but because billing teams weren’t using the latest information. Hence, preparing early is a crucial part of maintaining a healthy revenue cycle, and remaining fully aligned with payer expectations.
How the HCPCS Update Impacts Your Revenue Cycle?
By now it is clear that these new hydrophilic catheter code transitions will affect several core areas of your medical billing and operational performance. Here are some most important aspects that no practice can afford to overlook:
1. Higher Potential for Coding Errors
A shift of code is coming after many years, hence switching from long-standing codes to new and highly specific codes introduces new room for errors. Starting from EHR templates, billing software, charge masters, and clinical documentation everything has to be updated correctly,or else the claims may default to discontinued codes, triggering mass denials.
2. Stricter Documentation Expectations
Because the new codes specifically identify hydrophilic products, payers may require more detailed justification of medical necessity. This shift may influence both audit preparedness and day-to-day documentation standards that support compliance.
3. Updated Payer Rules & Prior Authorization
The commercial payers may align with CMS and introduce new requirements for the A4295–A4297 code set, including updates to prior authorization lists. It is important for the practices to monitor payer bulletins throughout these last two months of 2025 to avoid unexpected delays in 2026.
How Can Your Practice Start Preparing?
Since, the news codes are officially out and new year is just two months away, it is the perfect time to get prepared. To navigate this update smoothly, ensure:
- Update the billing software, charge masters, and EHR templates with latest HCPCS codes
- Start the order renewal workflows to obtain updated SWOs
- Begin listing down all patients currently using hydrophilic catheters
- Monitor the payer communications before 2026
- Audit current catheter claims for high-volume impact
- Train staff on documentation updates and coding changes
- Strengthening internal processes within your RCM team
Being proactive not only decreases the operational friction, but it protects cash flow, patient delivery timelines, and organizational stability.
Conclusion
The 2026 hydrophilic catheter HCPCS update is more than a coding revision, it is a shift that directly affects how practices bill, document, and remain compliant. With the introduction of A4295, A4296, and A4297, practices have to update orders, align documentation, and adjust internal DME billing processes to avoid unnecessary denials and maintain steady reimbursement.
Med Karma professionals can ensure that you are prepared ahead of time, your key revenue cycle workflows are strengthened, so that your practices can transition seamlessly into 2026.
Reference link: https://cgsmedicare.com/pdf/dme/point/dme-ttp-urological.pdf