An image of a catheter
Key strategies for HME suppliers to navigate new codes
by Kathryn Vaughn
Tuesday, March 11, 2025

January 2026 marks a pivotal moment for the urological medical supply landscape. The introduction of new Healthcare Common Procedure Coding System (HCPCS) codes for intermittent catheters with hydrophilic coatings is set to revolutionize how these products are classified, reimbursed and ultimately accessed by individuals who use intermittent catheters. There is a unique opportunity—and a responsibility—for home medical equipment (HME) suppliers to ensure a smooth transition and to advocate for reimbursement that supports access to hydrophilic coating technology. This article will provide a roadmap for navigating these changes and engaging in conversations with payers to ensure continued access to hydrophilic-coated catheters.

The Countdown to 2026: Understanding the New HCPCS Codes

The current HCPCS codes for intermittent catheters are limited and fail to distinguish between advanced catheter features and coating. The lack of specificity has contributed to low reimbursement by commercial and managed care payers and thus access challenges for individuals for use intermittent catheters. 

Hydrophilic coated catheters represent a significant step forward for intermittent catheterization. The specialized coating creates a smooth, low-friction surface that minimizes urethral trauma during insertion and removal.1,2 Clinical evidence supports the use of hydrophilic catheters, demonstrating their effectiveness in reducing the risk of urinary tract infections (UTIs)3 and improving patient comfort and satisfaction.4


The three new HCPCS codes, which will go into effect January 1, 2026, will provide the necessary differentiation for intermittent catheters with hydrophilic coating. In its final decision made in August 2024, the Centers for Medicare & Medicaid Services (CMS) acknowledges the unique clinical benefits and value these catheters offer. 

Why 2025 Is Crucial: Preparing for the Shift

While 2026 might seem distant, the next months are arguably the most critical for HME suppliers. This is the time to proactively prepare for the implementation of the new codes and lay the groundwork for supportive reimbursement for them. Suppliers are encouraged to take advantage of the time until implementation by focusing on:

  1. Internal Education: Ensure your entire team—from billing and coding specialists to customer service representatives—understands the new codes, their implications and the clinical rationale behind them.
  2. Data Collection: Gather data on the population using hydrophilic-coated catheters. This information will be invaluable when demonstrating the impact of these products to payers.
  3. Customizing Payer-Specific Value Propositions: Not all payers are alike. Craft tailored messages that highlight the clinical and economic benefits of hydrophilic catheters for different payer segments.

Talking to Payers: a Strategic Approach

The heart of a successful transition lies in effective communication with payers. The goal is to educate them about the value of hydrophilic-coated catheters and advocate for reimbursement that ensures continued patient access. Here are key strategies for engaging in productive conversations:

  • Start early: As mentioned above, don't wait until 2026. Begin engaging with payers now to introduce the new codes and explain their significance.
  • Focus on clinical benefits: Emphasize the evidence-based advantages of hydrophilic catheters, such as reduced UTI rates, decreased urethral trauma and improved patient satisfaction.
  • Highlight economic value: Highlight peer-reviewed published literature that showcases the cost-saving potential associated with hydrophilic catheters. 
  • Address concerns proactively: Anticipate potential questions or objections from payers and prepare clear, concise answers supported by data and clinical evidence.
  • Share cost of innovation: Consider sharing the difference between acquisition costs for non-hydrophilic and hydrophilic-coated catheters. 
  • Build relationships: Foster strong, collaborative relationships with key decision-makers at payer organizations. Regular communication and a proactive approach can go a long way.

Arming Yourself for Success: AAHomecare's Powerful Toolkit

To facilitate these crucial payer conversations and ensure a smooth transition, the American Association for Homecare (AAHomecare) Intermittent Catheter Coding Reform Committee (ICCRC), a coalition of manufacturers and suppliers, has developed a comprehensive toolkit of resources. These tools are designed to equip HME suppliers with the knowledge and materials needed to effectively advocate for appropriate reimbursement of hydrophilic catheters. AAHomecare will have a dedicated resource webpage that includes:

  • New Code Brief and Call to Action: A concise document outlining the new HCPCS codes and urging payers to adopt supportive coverage policies.
  • Payer Value Proposition Presentation: A ready-made presentation template that suppliers can customize to present the clinical and economic benefits of hydrophilic catheters to payers.
  • Clinical and Patient Society Sign-On Support Letter: A powerful letter demonstrating broad support from clinical experts and patient advocacy groups for appropriate reimbursement of hydrophilic technology.
  • AAHomecare Catheter Diagram: A clear, visual representation of different catheter types, highlighting the unique features of hydrophilic catheters.
  • Life of an Order: Urological Supplies: A detailed infographic illustrating the patient journey and the role of HME suppliers in providing care.
  • AAHomecare Urological Whitepaper: An in-depth report providing comprehensive information on the urological landscape, the importance of hydrophilic catheters and the need for appropriate reimbursement.
  • Transparency in Coverage Data via AAHomecare Medlyze Portal: Access to valuable data through the Medlyze portal, empowering suppliers to analyze coverage trends and make data-driven arguments to payers.

These resources will be invaluable assets as you prepare for and navigate the implementation of the new codes with payers. 

A United Front: the Power of Manufacturer & Supplier Coalition Support


The ICCRC is actively working throughout 2025 to ensure the successful implementation of the new codes. 

The coalition is committed to outreach to Medicaid plans to advocate for the adoption of the new codes and establishment of supportive reimbursement policies that reflect the value of hydrophilic coating technology. ICCRC will also continue dialogue with the Medicare Pricing, Data Analysis and Coding contractor to ensure products are correctly coded prior to the effective date. 

To secure continuity of coverage for hydrophilic-coated catheters, ICCRC will also work closely with Durable Medical Equipment Medicare Administrative Contractors (DME MACs). Perhaps most importantly, ICCRC will engage in ongoing education of all stakeholders, including payers, clinicians and policymakers about the importance of HCPCS implementation and the need for supportive reimbursement. 
This collective action underscores the industry's commitment to a smooth and successful transition in 2026.

Conclusion

The introduction of new HCPCS codes for hydrophilic catheters in 2026 is a watershed moment for the urological medical supply category. It's an opportunity for suppliers to be assertive and educate payers on the benefits of hydrophilic-coated catheters, the difference in costs for acquiring hydrophilic coated catheter technology and why reimbursement needs to be supportive for continued access. By proactively preparing for these changes and engaging in strategic conversations with payers, we can ensure a smooth transition and secure a future where all individuals who use intermittent catheters have access to the catheter that meets their unique needs.

References: 


1. Ali, S., Khan, O.S., Youssef, A.M. et al. Hydrophilic catheters for intermittent catheterization and occurrence of urinary tract infections. A retrospective comparative study in patients with spinal cord injury. BMC Urol, 24, 122 (2024). doi: 10.1186/s12894-024-01510-y.

2.Liao, X., Liu, Y., Liang, S. et al. Effects of hydrophilic coated catheters on urethral trauma, microtrauma and adverse events with intermittent catheterization in patients with bladder dysfunction: a systematic review and meta-analysis. Int Urol Nephrol 54, 1461–1470 (2022). doi: 10.1007/s11255-022-03172-x.

3. Plata M., Santander, J., Zuluaga, L. et al. Hydrophilic versus non-hydrophilic catheters for clean intermittent catheterization: a meta-analysis to determine their capacity in reducing urinary tract infections. World J Urol. 2022. 41(2), 491–499. Doi: 10.1007/s00345-022-04235-5.

4. Feng D, Cheng L, Bai Y, Yang Y, Han P. Outcomes comparison of hydrophilic and non-hydrophilic catheters for patients with intermittent catheterization: An updated meta-analysis. Asian J Surg. 2020 May;43(5):633-635. doi: 10.1016/j.asjsur.2019.12.009.
 


Kathryn Vaughn, PT, DPT, is director, market access and reimbursement for Coloplast. Before joining Coloplast she was director of market access for ReWalk Robotics, which makes powered exoskeletons. She spoke on this topic at Medtrade. Visit coloplast.us.