The Durable Medical Equipment Medicare Administrative Contractors (DME MAC) have finalized an important local coverage determination (LCD) update affecting intermittent catheter coverage for beneficiaries, especially those living with spinal cord injury (SCI) requiring urology care. As of January 1, 2026, Medicare will allow individuals with any spinal cord injury diagnosis to qualify for the A4353 sterile intermittent catheter kit without previously required conditions, such as recurrent urinary tract infections (UTIs). This policy change brings clinical evidence and coverage into closer alignment and represents a major shift in access to sterile catheter supplies for the neurogenic bladder community. Here, we'll discuss what the LCD change means, who qualifies, what documentation is required, and how to order catheters through a reputable medical supply company.
What Is an A4353 Sterile Intermittent Catheter Kit?
The A4353 code refers to a sterile intermittent catheter kit used by patients who require assistance in draining their bladder due to a permanent impairment of urination. These kits contain the catheter and all supplies needed for single-use, sterile intermittent catheterization in the home or care setting.
Intermittent catheterization is often preferable for reducing long-term complications like UTIs compared with indwelling catheters, especially for individuals with complex bladder management needs. The coverage applies regardless of whether an individual requires a straight tip catheter or coude tip catheter.
Medicare covers intermittent catheters under certain conditions through its durable medical equipment (DME) benefit when the item is deemed reasonable and necessary for the beneficiary’s care.
Key Medicare LCD Policy Changes Effective January 1, 2026
The proposal submitted to revise the LCD focused on broadening the coverage criteria for patients with spinal cord injury to receive sterile intermittent catheter kits coverage by insurance, as they are considered reasonable and necessary durable medical equipment. The revised LCD went beyond the proposal and clarified coverage to allow for SCI at any level. Some of the key changes currently in effect include the following.
1. Spinal Cord Injury as a Qualifying Condition
Under the revised Urological Supplies LCD (L33803) and accompanying policy article, Medicare has added spinal cord injury (SCI) as a qualifying condition that automatically satisfies the immunosuppression criterion for sterile catheter coverage.
Regarding the new LCD, AAHomecare announced, "The clarification streamlines coverage by allowing documentation of SCI alone to automatically qualify a beneficiary as immunocompromised for sterile catheter kits, allowing patients access to sterile kits without requiring them to have two urinary tract infections (UTIs)."
In short:
- A diagnosis of SCI alone, at any neurological level, is now sufficient for Medicare beneficiaries to qualify for A4353 and A4297 sterile catheter kits as a medical necessity, without requiring evidence of two UTIs or other immunocompromised conditions.
- This change aligns Medicare coverage with clinical evidence showing that SCI patients are at increased risk for infection and other complications, making catheterization
2. Elimination of Prior UTI Requirement for SCI Patients
Previously, beneficiaries with a spinal cord injury typically had to demonstrate:
- Evidence of two urinary tract infections (UTIs) within a 12-month period
- Or other immunocompromised states in addition to SCI
With the new policy, this requirement has been removed for individuals with any documented SCI, streamlining access to sterile catheter supplies and reducing bureaucratic barriers. This also removes the need for delays caused by looking up previous medical records.
3. Incorporation of New HCPCS Codes
In conjunction with the LCD update, Medicare has added three new HCPCS codes (A4295, A4296, A4297) to distinguish hydrophilic intermittent catheters and updated coverage guidelines for existing codes. These changes support better billing practices and more precise coding for advanced catheter products that may reduce urethral trauma and infection risk.
The Importance of the LCD Policy Update for Individuals with SCI
For patients living with spinal cord injuries, sterile catheterization is not optional. It's something that's essential to maintaining quality of life while reducing risk of severe complications like sepsis, kidney damage, autonomic dysreflexia, and recurrent UTIs. Historically, Medicare coverage criteria often fell short of matching clinical need. With this update:
- Patients no longer face additional barriers to accessing daily, sterile catheter supplies
- Providers can prescribe A4353 kits with clearer expectations for Medicare coverage
Advocacy organizations emphasized that the previous criteria led to unnecessary gaps in care, often putting SCI patients at risk for preventable hospitalizations. The expanded LCD is widely regarded as a critical step toward evidence-based policy.
Eligibility: Who Qualifies Under the New LCD?
Medicare beneficiaries with a documented spinal cord injury diagnosis in their medical record now qualify for A4353 sterile catheter kits if they meet the general Medicare criteria for catheter use:
- Permanent impairment of urination
- Demonstrated need for intermittent catheterization
- Physician documentation supporting the condition and necessity
However, beneficiaries no longer need to prove they had two UTIs within a year to meet immunosuppression criteria if they have SCI, which historically was a barrier for many patients.
Other Neurologic Conditions Still Evaluated Case-by-Case
While SCI now automatically qualifies under immunosuppression criteria, other neurogenic bladder etiologies, such as spina bifida or multiple sclerosis, may still require additional documentation or reviews to qualify under existing LCD categories, though advocacy groups are urging expansion in the future.
Medical Documentation Requirements
Suppliers and providers must ensure accurate documentation to support Medicare reimbursement:
- Written Order Prior to Delivery (WOPD): A signed physician order specifying the need for A4353 sterile catheter kits
- Medical Record Documentation: Must support the SCI diagnosis and permanent impairment of urination
- Documentation should also establish that intermittent catheterization is medically necessary for the patient’s condition.
Even with SCI, documentation that the beneficiary’s bladder dysfunction is permanent and that sterile intermittent catheter use is clinically indicated is essential. This reduces claim denials and streamlines supplier workflows.
Partner with a Medical Supply Company for Urological Supplies
The 2026 LCD update for urological supplies is a significant win for individuals with spinal cord injuries. By explicitly recognizing SCI as a qualifying condition for A4353 sterile intermittent catheter kits, Medicare is removing unnecessary barriers to care and aligning policy with clinical realities. This change enhances patient well-being, supports better clinical outcomes, and simplifies administrative processes for providers and DME suppliers alike.
Byram Healthcare remains committed to helping patients and providers understand Medicare updates and navigate the supply ordering process effectively. If you have specific questions about A4353 coverage under the new LCD, contact us today.
