CMS Proposes New Intermittent Catheter HCPCS Codes

WASHINGTON—Last week, the Centers for Medicare & Medicaid Services (CMS) released the 2024 Bi-Annual HCPCS Public Meeting Agenda for May 28-30. The first topic listed in the May 28 Agenda is CMS’s proposal to expand the HCPCS codes list for intermittent catheters (ICs). The request was submitted by the American Association for Homecare (AAHomecare) based on the analysis and review by the Intermittent Catheter Coding Reform Coalition (ICCRC), a coalition of IC manufacturers.

CMS proposes to modify the current three IC HCPCS codes to six HCPCS codes—establishing five new IC codes to distinguish the coating types and discontinuing existing codes that do not distinguish coating types, A4351 and A4352. CMS will maintain A4353 as is. CMS also plans to maintain pricing continuity as per regulatory requirements when implementing the new codes. This would entail mapping previous fee schedule amounts for discontinued codes to the new ones to ensure consistent pricing. 
 
Pending further feedback and final determination, CMS anticipates the proposed changes to take effect on Jan. 1, 2026. The ICCRC said it is pleased that CMS has established new HCPCS codes for intermittent catheters, recognizing hydrophilic features separately from other catchers. AAHomecare, in collaboration with ICCRC, will be commenting on the proposed changes.

You can find the proposal on pages 3-8 of the May 28th HCPCS Public Meeting Agenda.