A4295 HCPCS code: Intermittent urinary catheter; straight tip, hydrophilic coating, each
A4295 is the HCPCS Level II code for intermittent urinary catheter; straight tip, hydrophilic coating, each. The 2026 Medicare DMEPOS fee schedule pays $1.61 to $2.58 depending on the state. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 600 per day on DME suppliers. Its average fee ranks 4 of 18 A42 codes (family range $0.61–$273.28).
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 37 — DMEPOS: ostomy, tracheostomy and urological supplies |
| BETOS category | D1F — Prosthetic and orthotic devices |
| Added | 2026-01-01 |
| Last action effective | 2026-01-01 |
2026 Medicare DMEPOS fee schedule for A4295
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $1.61 | $2.58 | $2.58 | $2.19 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $1.61 | — |
| AL | — | $2.58 | — |
| AR | — | $2.43 | — |
| AZ | — | $2.58 | — |
| CA | — | $2.19 | — |
| CO | — | $2.19 | — |
| CT | — | $2.58 | — |
| DC | — | $2.46 | — |
| DE | — | $2.46 | — |
| FL | — | $2.58 | — |
| GA | — | $2.57 | — |
| HI | — | $1.69 | — |
| IA | — | $2.58 | — |
| ID | — | $2.19 | — |
| IL | — | $2.58 | — |
| IN | — | $2.19 | — |
| KS | — | $2.58 | — |
| KY | — | $2.19 | — |
| LA | — | $2.43 | — |
| MA | — | $2.58 | — |
| MD | — | $2.58 | — |
| ME | — | $2.58 | — |
| MI | — | $2.58 | — |
| MN | — | $2.58 | — |
| MO | — | $2.58 | — |
| MS | — | $2.39 | — |
| MT | — | $2.19 | — |
| NC | — | $2.19 | — |
| ND | — | $2.19 | — |
| NE | — | $2.58 | — |
| NH | — | $2.58 | — |
| NJ | — | $2.46 | — |
| NM | — | $2.58 | — |
| NV | — | $2.58 | — |
| NY | — | $2.19 | — |
| OH | — | $2.43 | — |
| OK | — | $2.58 | — |
| OR | — | $2.58 | — |
| PA | — | $2.46 | — |
| PR | — | $2.11 | — |
| RI | — | $2.58 | — |
| SC | — | $2.58 | — |
| SD | — | $2.19 | — |
| TN | — | $2.19 | — |
| TX | — | $2.58 | — |
| UT | — | $2.19 | — |
| VA | — | $2.32 | — |
| VI | — | $2.19 | — |
| VT | — | $2.58 | — |
| WA | — | $2.58 | — |
| WI | — | $2.58 | — |
| WV | — | $2.43 | — |
| WY | — | $2.19 | — |
How the A4295 fee compares
| Measure | Value |
|---|---|
| Rank among 18 A42 codes (lowest = 1) | 4 |
| Family fee range (average of state fees) | $0.61–$273.28 |
| Rural fee uplift | — |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 600 | Published Contractor Policy |
| outpatient hospital claims | 2 | Nature of Equipment |
Medicare policy articles for this code
- A52521: Urological Supplies - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (1 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| N39.3 | Stress incontinence (female) (male) | 1 |
What changed for A4295
- January 2026: Code appears in this HCPCS release
- 2026-01-01: A4295 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4295?
A4295 is the HCPCS Level II code for intermittent urinary catheter; straight tip, hydrophilic coating, each. Short descriptor: "Straigh tip hydrophilic cath".
How much does Medicare pay for A4295?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $1.61–$2.58. Rural fees can be higher.
Does Medicare cover A4295?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4295?
Medicare policy articles that cite A4295 list 1 covered ICD-10-CM diagnosis codes across 1 article. The most cited include N39.3 (Stress incontinence (female) (male)). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of A4295 can be billed per day?
600 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).
Related A42 codes
- A4206 — Syringe with needle, sterile, 1 cc or less, each
- A4207 — Syringe with needle, sterile 2 cc, each
- A4208 — Syringe with needle, sterile 3 cc, each
- A4209 — Syringe with needle, sterile 5 cc or greater, each
- A4210 — Needle-free injection device, each
- A4211 — Supplies for self-administered injections
- A4212 — Non-coring needle or stylet with or without catheter
- A4213 — Syringe, sterile, 20 cc or greater, each
- A4215 — Needle, sterile, any size, each
- A4216 — Sterile water, saline and/or dextrose, diluent/flush, 10 ml ($0.53–$0.99)
- A4217 — Sterile water/saline, 500 ml ($2.18–$4.93)
- A4218 — Sterile saline or water, metered dose dispenser, 10 ml
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Next steps
- Run a reimbursement report for a device billed under A4295
- Watch A4295 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4295
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.