A4295, A4296 and A4297 take effect
Code added · high importance
- Announced
- 2025-07-17
- Effective
- 2026-01-01
Three codes for hydrophilic intermittent urinary catheters became effective for dates of service on or after January 1, 2026: A4295 for a straight tip, A4296 for a coude tip, and A4297 for a hydrophilic catheter supplied with insertion supplies. Before them, a hydrophilic coating was invisible to the code set.
The four DME MACs announced the codes jointly in July 2025, six months ahead. The Jurisdiction C supplier manual prints all three in Appendix A, each stamped with an effective date of 01/01/2026.
Codes this entry bears on
Sources
- [1] Documentation Requirements for New Urological Supplies Codes · Joint DME MAC Publication (Noridian Healthcare Solutions and CGS Administrators) · checked 2026-08-07
A JOINT DME MAC PUBLICATION, NOT A NORIDIAN ARTICLE, and it says so in its own subheading. The identical text is published by all four jurisdictions and every copy was fetched on 2026-08-07: Noridian JA (this URL, HTTP 200, 143,027 bytes), Noridian JD at .../web/jddme/policies/dmd-articles/2025/documentation-requirements-for-new-urological-supplies-codes, and CGS JB and JC at cgsmedicare.com/{jb,jc}/pubs/news/2025/07/cope181960.html (HTTP 200, 40,620 bytes for JC). One jurisdiction's URL is used as the anchor. This is the source of the conditional order rule, and reading only one branch of its two-question Q&A is how the blanket "every order must be rewritten" version got into circulation.
- [2] Supplier Manual, Summer 2026 (DME MAC Jurisdiction C), Appendix A · CGS Administrators, LLC (DME MAC Jurisdiction C) · checked 2026-08-07
CITE THE APPENDIX AND THE PAGE, NOT THE FILE. The relevant content is Appendix A, Level II HCPCS Codes: A4295, A4296 and A4297 on PDF page 249, A4351 to A4353 on page 250, and the transanal irrigation codes on pages 254 to 255. PDF, HTTP 200, 5,694,794 bytes, 448 pages, fetched 2026-08-07. Programmatic extraction needs a crypto backend: the file is AES-encrypted with an empty user password, so pypdf alone raises a dependency error and pypdf with cryptography reads all 448 pages with no password prompt. THE MANUAL CARRIES NO COVERAGE OR QUANTITY RULES, and says so: "The Level II HCPCS listed in Appendix A of this manual are provided as a guide for identifying items that are processed by the DME MACs. The appearance of a code in the appendix does not necessarily indicate coverage." Cited here for the descriptors as the DME MAC prints them, each stamped with its effective date.
- [3] MLN Matters MM14326, DMEPOS Fee Schedule: CY 2026 Update · Centers for Medicare and Medicaid Services · checked 2026-08-07
Change Request 14326, revised release date 2026-01-30, effective 2026-01-01, transmittals R13519CP and R13610CP. PDF, HTTP 200, 243,386 bytes, 7 pages, fetched and text-extracted on 2026-08-07. This is CMS in its own words on both halves of the January change: "We added fee schedule amounts to the DMEPOS fee schedule file for new HCPCS codes, including: A4295, A4296, A4297" and "Starting January 1, 2026, we revised the descriptors for HCPCS codes A4351 and A4352. There are no changes to the existing fee schedule amounts for these codes."