Two Codes Carry 95% of Medicare's New Denials

If you have been waiting to see whether Medicare actually did anything about the catheter numbers, Tuesday's file answers it.

CMS refreshed the Physician/Supplier Procedure Summary on August 11, adding the CY2025 edition. It is the annual roll-up of every Part B carrier and DME claim by HCPCS code, modifier, provider specialty, locality and place of service, 14,474,585 rows of it, and it carries two fields almost nobody opens: denied services and denied charges, sitting right next to submitted and allowed.

Run the CY2025 edition against CY2024 and Medicare's denial rate on submitted Part B service units goes from 10.89% to 15.68% in a single year.

That is 587.9 million more denied service units on submitted volume that grew only 25.7%. Denied submitted charges went from $39.27 billion to $46.76 billion.

Two codes did 94.9% of it.

Where the Half Billion Went

A4352 is the coude-tip intermittent urinary catheter. Submitted units went from 31.4 million in CY2024 to 912.8 million in CY2025, a 29x jump, and the share Medicare denied went from 4.16% to 37.20%. Denied charges on that one code: $2.590 billion, against $16.4 million the year before.

A4353, the intermittent catheter with insertion supplies, went from 197.5 million submitted units to 505.4 million and from 20.46% denied to 51.42%. Denied charges: $1.737 billion.

Between them, 557.7 million of the 587.9 million new denied units. Straight-tip A4351 adds 12.5 million more on a rate that nearly tripled, to 15.55%.

We ran the CERT half of this on August 8: urological supplies at 74.1% improper, and A4353 alone projecting $851.5 million in overpayments off a 44-claim sample. That file's window closed with claims submitted in June 2024.

This one is the year after, and it is what the edits look like when they land.