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HCPCS A4297 · Level II · A code

A4297: Intermittent urinary catheter; hydrophilic coating, with insertion supplies, 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 A4297

Medicare payment
$9.97 to $9.99
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

CMS describes HCPCS A4297, added in 2026, as "Intermittent urinary catheter; hydrophilic coating, with insertion supplies". A4297 is paid from the DMEPOS fee schedule as ostomy, tracheostomy and urological items (OS): $9.97 in CT, DC, DE and 15 more to $9.99 in AL, AR, AZ and 28 more (floor $8.49, ceiling $9.99), October 2026. MUE limits for A4297: practitioner 1 (MAI 3, Nature of Equipment); hospital outpatient 3 (MAI 3, Nature of Equipment); DME supplier 600 (MAI 3, Published Contractor Policy). 1 active LCD lists A4297: 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, A4295.

A4297 descriptor and code status

The October 2026 HCPCS Level II file describes A4297 as “Intermittent urinary catheter; hydrophilic coating, with insertion supplies”. 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 A4297
FieldValue
Short descriptorHydrophilic coat insert sup
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 A4297

A4297 is paid from the DMEPOS fee schedule as ostomy, tracheostomy and urological items (OS): $9.97 in CT, DC, DE and 15 more to $9.99 in AL, AR, AZ and 28 more (floor $8.49, ceiling $9.99), October 2026. 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 A4297 by modifier
ModifierFloor / ceilingNon-rural state rangeRural rangeAK / HI / PR / VI
none$8.49 / $9.99$9.97 (CT, DC, DE…) to $9.99 (AL, AR, AZ…)—AK $10.06, HI $10.75, PR $10.97, VI $9.99

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 A4297

MUE limits for A4297: practitioner 1 (MAI 3, Nature of Equipment); hospital outpatient 3 (MAI 3, Nature of Equipment); DME supplier 600 (MAI 3, Published Contractor Policy). 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 A4297 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services13 Date of Service Edit: ClinicalNature of Equipment
Facility outpatient hospital33 Date of Service Edit: ClinicalNature of Equipment
DME supplier6003 Date of Service Edit: ClinicalPublished Contractor Policy

The MUE lookup for A4297 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists A4297 in v323r0.

A4297 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 A4297 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for A4297

1 active Local Coverage Determination and 0 billing and coding articles list A4297. 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 A4297

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists A4297

CARC 151 · N362

units of A4297 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 A4297 claims

QuickAuth coordinates the requirement checks and documentation that DME claims for A4297 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 A4297

What does HCPCS code A4297 describe?

"Intermittent urinary catheter; hydrophilic coating, with insertion supplies" (short descriptor "Hydrophilic coat insert sup"), in the A section (transportation, medical and surgical supplies, administrative, miscellaneous and investigational). Added 2026-01-01.

Is A4297 a CPT code?

No: CMS maintains A4297 in HCPCS Level II, while the AMA maintains CPT. It goes in the same procedure-code field.

What does Medicare pay for A4297?

A4297 is paid from the DMEPOS fee schedule as ostomy, tracheostomy and urological items (OS): $9.97 in CT, DC, DE and 15 more to $9.99 in AL, AR, AZ and 28 more (floor $8.49, ceiling $9.99), October 2026.

How many units of A4297 can be billed per day?

MUE limits for A4297: practitioner 1 (MAI 3, Nature of Equipment); hospital outpatient 3 (MAI 3, Nature of Equipment); DME supplier 600 (MAI 3, Published Contractor Policy). 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 A4297?

Coverage code D (special coverage instructions apply). 1 active LCD lists A4297: 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.