|
Attention medical equipment and supplies providers:
Effective retroactively for claims with dates of service on and after January 1, 2026, the Health Care Authority (HCA) added new HCPCS codes for urological and incontinent supplies with hydrophilic coating. To improve billing accuracy, the Centers for Medicare and Medicaid Services (CMS) created these additional codes to specifically distinguish hydrophilic-coated catheters from non-hydrophilic catheters.
What are the new codes?
- A4295 Intermittent urinary catheter; straight tip, hydrophilic coating, each – not to be billed in combination with A4351, maximum of 180 allowed per client, per month
- A4296 Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each – not to be billed in combination with A4352, maximum of 180 allowed per client, per month
- A4297 Intermittent urinary catheter; hydrophilic coating, with insertion supplies – not to be billed in combination with A4353 or A4354, maximum of 180 allowed per client, per month
Is prior authorization required?
No. Prior authorization is not required.
Do we have to rebill claims already submitted for dates of service on and after January 1, 2026?
Yes. Providers who have already billed for hydrophilic-coated catheters using HCPCS codes A4351 (instead of new code A4295), A4352 (instead of new code A4296), or A4353 (instead of new code A4297) must rebill claims using the correct codes. The new codes will be effective in the ProviderOne system on April 1, 2026.
See the What has changed table in the most recent Medical Equipment and Supplies Billing Guide for additional information, billing provisions, and limitations. The associated fee schedule will be published by April 1, 2026, to reflect these changes.
|
