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HCPCS A4295 · Level II · A code

A4295: Intermittent urinary catheter; straight tip, hydrophilic coating, each, HCPCS Level II A code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); DMEPOS fee schedule: DME26-D (October 2026) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and DMEPOS fee schedule and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for A4295

Medicare payment
$2.19 to $2.58
DMEPOS non-rural state fees
Coverage code
D
special coverage instructions apply
DME supplier MUE
600
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

A4295 is a Level II code from the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), in use since 2026: "Intermittent urinary catheter; straight tip, hydrophilic coating, each". The October 2026 DMEPOS fee schedule (category OS, ostomy, tracheostomy and urological items) sets A4295 at $2.19 in CA, CO, ID and 10 more to $2.58 in AL, AZ, CT and 22 more (floor $2.19, ceiling $2.58). CMS caps A4295 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Equipment); DME supplier 600 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. 1 active LCD lists A4295: L33803 (Urological Supplies). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS D1F (prosthetic/orthotic devices); pricing indicator 37; type of service P (lump-sum purchase of DME, prosthetics or orthotics). 5 other active codes open with "Intermittent urinary catheter"; related codes: A4351, A4353, A4296, A4297.

A4295 descriptor and code status

The October 2026 HCPCS Level II file describes A4295 as “Intermittent urinary catheter; straight tip, hydrophilic coating, each”. It sits in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational), listed with the other A codes.

HCPCS file attributes of A4295
FieldValue
Short descriptorStraigh tip hydrophilic cath
Added to HCPCS2026-01-01
Last actionN (no maintenance), effective 2026-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator37: DMEPOS ostomy, tracheostomy and urological supplies (floors and ceilings)
BETOS categoryD1F: prosthetic/orthotic devices
Type of serviceP: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for A4295

The October 2026 DMEPOS fee schedule (category OS, ostomy, tracheostomy and urological items) sets A4295 at $2.19 in CA, CO, ID and 10 more to $2.58 in AL, AZ, CT and 22 more (floor $2.19, ceiling $2.58). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

DMEPOS fee schedule (DME26-D)

Jurisdiction D (DME MAC), payment category OS (ostomy, tracheostomy and urological items). Fees are set per state; AK, HI, PR and VI are not subject to the national ceiling and floor and are listed separately. A rural fee applies only in ZIP codes on the CMS rural ZIP list.

DMEPOS fees for A4295 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$2.19 / $2.58$2.19 (CA, CO, ID…) to $2.58 (AL, AZ, CT…)—AK $1.61, HI $1.69, PR $2.11, VI $2.19

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Medically Unlikely Edits for A4295

CMS caps A4295 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Equipment); DME supplier 600 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. The DME supplier MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for A4295 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital23 Date of Service Edit: ClinicalNature of Equipment
DME supplier6003 Date of Service Edit: ClinicalPublished Contractor Policy

The MUE lookup for A4295 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4295 in v323r0.

A4295 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check A4295 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4295

1 active Local Coverage Determination and 0 billing and coding articles list A4295. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on A4295

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A4295

CARC 151 · N362

units of A4295 exceed the DME supplier MUE of 600 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for A4295 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4295 depend on, with human review of each case, and QuickRCM carries claim readiness and the CARC 50, 151 and modifier denials these items draw.

See QuickAuth for requirement checksSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS A4295

What does HCPCS code A4295 describe?

"Intermittent urinary catheter; straight tip, hydrophilic coating, each" (short descriptor "Straigh tip hydrophilic cath"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2026-01-01.

Is A4295 a CPT code?

It is not. A4295 belongs to the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for A4295?

The October 2026 DMEPOS fee schedule (category OS, ostomy, tracheostomy and urological items) sets A4295 at $2.19 in CA, CO, ID and 10 more to $2.58 in AL, AZ, CT and 22 more (floor $2.19, ceiling $2.58).

How many units of A4295 can be billed per day?

CMS caps A4295 at practitioner 0 (MAI 3, CMS Policy); hospital outpatient 2 (MAI 3, Nature of Equipment); DME supplier 600 (MAI 3, Published Contractor Policy) units per day in the 2026 Q4 MUE tables. For the DME supplier MUE (MAI 3), units above 600 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover A4295?

Coverage code D (special coverage instructions apply). 1 active LCD lists A4295: L33803 (Urological Supplies).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.