A4296 HCPCS code: Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each
A4296 is the HCPCS Level II code for intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each. The 2026 Medicare DMEPOS fee schedule pays $7.78 to $15.27 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 11 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 A4296
| Modifier | Meaning | Lowest state fee | Highest state fee | Ceiling | Floor |
|---|---|---|---|---|---|
| — | base fee | $7.78 | $15.27 | $9.15 | $7.78 |
| State | Modifier | Fee | Rural fee |
|---|---|---|---|
| AK | — | $14.30 | — |
| AL | — | $9.15 | — |
| AR | — | $7.78 | — |
| AZ | — | $9.15 | — |
| CA | — | $9.15 | — |
| CO | — | $8.88 | — |
| CT | — | $9.15 | — |
| DC | — | $9.15 | — |
| DE | — | $9.15 | — |
| FL | — | $7.78 | — |
| GA | — | $8.99 | — |
| HI | — | $15.27 | — |
| IA | — | $9.15 | — |
| ID | — | $9.15 | — |
| IL | — | $7.78 | — |
| IN | — | $7.78 | — |
| KS | — | $9.15 | — |
| KY | — | $7.78 | — |
| LA | — | $7.78 | — |
| MA | — | $9.15 | — |
| MD | — | $9.15 | — |
| ME | — | $9.15 | — |
| MI | — | $7.78 | — |
| MN | — | $7.78 | — |
| MO | — | $9.15 | — |
| MS | — | $9.15 | — |
| MT | — | $7.78 | — |
| NC | — | $8.44 | — |
| ND | — | $7.78 | — |
| NE | — | $9.15 | — |
| NH | — | $9.15 | — |
| NJ | — | $9.15 | — |
| NM | — | $7.81 | — |
| NV | — | $9.15 | — |
| NY | — | $9.15 | — |
| OH | — | $7.78 | — |
| OK | — | $7.81 | — |
| OR | — | $9.15 | — |
| PA | — | $9.15 | — |
| PR | — | $11.08 | — |
| RI | — | $7.78 | — |
| SC | — | $9.15 | — |
| SD | — | $7.78 | — |
| TN | — | $7.78 | — |
| TX | — | $9.11 | — |
| UT | — | $7.78 | — |
| VA | — | $9.15 | — |
| VI | — | $9.15 | — |
| VT | — | $9.15 | — |
| WA | — | $9.15 | — |
| WI | — | $7.78 | — |
| WV | — | $7.78 | — |
| WY | — | $7.78 | — |
How the A4296 fee compares
| Measure | Value |
|---|---|
| Rank among 18 A42 codes (lowest = 1) | 11 |
| 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 A4296
- January 2026: Code appears in this HCPCS release
- 2026-01-01: A4296 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 A4296?
A4296 is the HCPCS Level II code for intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each. Short descriptor: "Coude tip hydrophilic cath".
How much does Medicare pay for A4296?
Under the 2026 DMEPOS fee schedule, non-rural state fees are base (base fee): $7.78–$15.27. Rural fees can be higher.
Does Medicare cover A4296?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for A4296?
Medicare policy articles that cite A4296 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 A4296 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 A4296
- Watch A4296 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4296
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.