If you use catheters and rely on Medicare coverage, 2026 just brought some major changes to how your supplies are ordered and coded. The good news? These updates are designed to give you more options and better recognize the different types of catheters available today.

The not-so-good news? You might need to update your paperwork.

Let’s break down exactly what changed on January 1, 2026, and what you need to do before your next catheter order.

1. Three Brand New Codes for Hydrophilic Catheters

Medicare introduced three new HCPCS codes specifically for hydrophilic catheters (those pre-lubricated catheters that glide more easily):

• A4295 – Straight tip hydrophilic catheter
• A4296 – Coude (curved) tip hydrophilic catheter
• A4297 – Closed system hydrophilic catheter

Before this change, over 1,300 different catheter products were squeezed into just 3 codes. That’s like trying to describe every car model using only three categories. This new system gives suppliers and Medicare better ways to differentiate between products and recognize catheter innovations.

2. Old Non-Hydrophilic Codes Got a Makeover

The existing codes A4351 and A4352 are still around, but their definitions changed. They now explicitly cover non-hydrophilic catheters only:

• A4351 – Intermittent urinary catheter; straight tip, with or without coating (Teflon, silicone, or silicone elastomer)
• A4352 – Intermittent urinary catheter; coude (curved) tip, with or without coating

If you use non-hydrophilic catheters, your codes didn’t change. But if you use hydrophilic catheters, keep reading: this affects you directly.

3. Stop Using the Old Code A4353

Here’s where it gets important: A4353 is officially discontinued for claims dated January 1, 2026 or later.

If your supplier tries to bill using the old A4351, A4352, or A4353 codes for hydrophilic catheters after January 1, Medicare will likely deny the claim. Make sure your supplier knows to use the new A4295, A4296, or A4297 codes instead.

4. You Might Need a New Standard Written Order (SWO)

This is the most important action item for many catheter users.

If your current Standard Written Order (SWO) lists the old codes: A4351, A4352, or A4353: you’ll need to get a new one from your doctor. The new SWO should reference either:

• The new codes (A4295, A4296, A4297), OR
• General descriptions like “hydrophilic catheter” along with your preferred brand or model number

Good news: If your existing SWO already uses general descriptions (like “intermittent catheter, hydrophilic coating” or lists specific brand names), you don’t need a new order. Your current paperwork should work just fine.

5. New Orders Should Specify Your Catheter Type

When your doctor writes a new SWO, it should include:

• Catheter tip type (straight, coude, or closed system)
• Coating type (“hydrophilic” or “non-hydrophilic”)

Notice what’s NOT required? The specific HCPCS code. Your doctor doesn’t need to memorize billing codes: just clear descriptions of what you need. This actually makes things easier for prescribers while ensuring you get the right products.

6. Your Monthly Quantity Stays the Same

Nothing changed here, which is good news. Medicare still covers up to 200 catheters per month for both hydrophilic and non-hydrophilic types.

If you’ve been getting 150 catheters monthly, you’ll continue getting 150. If you need 200, that limit hasn’t changed. This update was about coding accuracy, not cutting coverage.

7. Pricing Remains Stable (For Now)

Medicare used what’s called “crosswalking” for reimbursement rates. This means the payment amounts for the new codes match the old codes: no sudden price changes or payment disruptions.

Regulatory requirements prevented CMS from changing rates simply because they divided one code into multiple codes. For you as a beneficiary, this means your copays and out-of-pocket costs should remain consistent.

8. Coverage Rules Didn’t Change

The clinical criteria for who qualifies for catheter coverage stayed exactly the same. Medicare added the new codes to existing Urological Local Coverage Determinations (LCDs) without changing medical necessity requirements.

If you qualified for coverage before January 1, 2026, you still qualify now. The codes changed, but the rules didn’t.

9. Watch for Competitive Bidding Changes Coming Soon

Here’s something to keep on your radar: CMS announced plans to include urological supplies in its competitive bidding program.

What does this mean? Eventually (likely later in 2026), Medicare may contract with approximately eight national suppliers who submit the lowest bids. Beneficiaries would then need to choose from products offered by those contract suppliers.

This could limit your product choices compared to what’s available now. Implementation details are expected in late Spring or Summer 2026, so stay tuned and talk to your supplier about how this might affect you.

10. Product Crosswalk Tool Available

Medicare’s Pricing, Data Analysis and Coding (PDAC) contractor created a Hydrophilic Intermittent Urinary Catheter Crosswalk tool to help identify which products move to which new codes.

This tool is primarily for suppliers and manufacturers, but if you’re curious about how your specific catheter brand is coded under the new system, your supplier should be able to look this up for you. The PDAC updates this crosswalk regularly as manufacturers submit product information.

What You Should Do Right Now

Don’t wait until you’re out of supplies to sort this out. Here’s your action plan:

Step 1: Check your current Standard Written Order. Does it list specific HCPCS codes or general descriptions?

Step 2: If it lists old codes (A4351, A4352, or A4353) and you use hydrophilic catheters, contact your doctor for an updated SWO.

Step 3: Call your catheter supplier at Fusion Medical Supplies to confirm they’re using the correct new codes for your orders.

Step 4: Verify your next order processes smoothly. If Medicare denies the claim, it’s likely a coding issue that can be fixed with proper documentation.

Step 5: Save your supplier’s contact information and keep communication open about any competitive bidding changes coming later this year.

The Bottom Line

These Medicare changes are meant to improve how catheters are categorized and billed: ultimately giving you access to a wider range of products that better meet your needs. But like any healthcare system update, there’s a transition period where paperwork needs updating.

Take action now to avoid delays in your next catheter delivery. A quick call to your doctor and your supplier can save you headaches down the road.

Got questions about how these changes affect your specific situation? Reach out to our team at Fusion Medical Supplies. We’re here to help you navigate Medicare’s requirements and ensure you get the supplies you need, when you need them.