A4297 — Intermittent urinary catheter; hydrophilic coating, with insertion supplies
A4297 is a HCPCS Level II code for intermittent urinary catheter; hydrophilic coating, with insertion supplies. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusX
Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A4297 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 1 unit MAI 3 — Date of Service Edit: Clinical · Nature of Equipment
- outpatient
- 3 units MAI 3 — Date of Service Edit: Clinical · Nature of Equipment
- DME supplier
- 600 units MAI 3 — Date of Service Edit: Clinical · Published Contractor Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A4297
- Long descriptor
- Intermittent urinary catheter; hydrophilic coating, with insertion supplies
- Short descriptor
- Hydrophilic coat insert sup
- Added
- January 1, 2026
- BETOS
- D1F
- Pricing indicator
- 37 — DMEPOS
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Ostomy, tracheostomy and urological supplies. Price subject to floors and ceilings.
Codes adjacent to A4297
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4297 is not quite right, the correct code is very often within a few positions of it.
- A4284Breast shield and splash protector for use with breast pump, replacement
- A4285Polycarbonate bottle for use with breast pump, replacement
- A4286Locking ring for breast pump, replacement
- A4287Disposable collection and storage bag for breast milk, any size, any type, each
- A4288Valve for breast pump, replacement
- A4290Sacral nerve stimulation test lead, each
- A4295Intermittent urinary catheter; straight tip, hydrophilic coating, each
- A4296Intermittent urinary catheter; coude (curved) tip, hydrophilic coating, each
- A4300Implantable access catheter, (e.g., venous, arterial, epidural subarachnoid, or peritoneal, etc.) external access
- A4301Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.)
- A4305Disposable drug delivery system, flow rate of 50 ml or greater per hour
- A4306Disposable drug delivery system, flow rate of less than 50 ml per hour
- A4310Insertion tray without drainage bag and without catheter (accessories only)
- A4311Insertion tray without drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.)
- A4312Insertion tray without drainage bag with indwelling catheter, foley type, two-way, all silicone
- A4313Insertion tray without drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation
Questions about A4297
What is HCPCS code A4297?
A4297 is a HCPCS Level II code for intermittent urinary catheter; hydrophilic coating, with insertion supplies. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4297?
The CMS HCPCS file marks A4297 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is A4297 paid under the physician fee schedule?
A4297 carries PFS status code X. Statutory exclusion. The item or service is not within the statutory definition of 'physician services', so the fee schedule never pays it.