How To Use HCPCS Code A4267

HCPCS code A4267 describes a male condom, which is a contraceptive supply used to prevent pregnancy and reduce the risk of sexually transmitted infections (STIs). This code is not payable by Medicare and does not require any maintenance. It was added to the Healthcare Common Procedure Coding System on January 01, 2003, and has a pricing indicator code of 00, indicating that it is not separately priced by Part B.

1. What is HCPCS A4267?

HCPCS code A4267 is used to identify a male condom, which is a barrier method of contraception. It is a sheath-like device that is worn over the penis during sexual intercourse to prevent sperm from entering the vagina. Male condoms are made of latex, polyurethane, or natural materials such as lambskin. They are an effective and widely available form of contraception that also provides protection against STIs.

2. Official Description

The official description of HCPCS code A4267 is “Contraceptive supply, condom, male, each.” This short description accurately reflects the purpose and nature of the code.

3. Procedure

1. Before using a male condom, carefully check the packaging for any signs of damage or expiration.
2. Open the package carefully to avoid tearing the condom.
3. Ensure that the penis is erect before putting on the condom.
4. Pinch the tip of the condom to leave a small reservoir for semen.
5. Unroll the condom all the way down the shaft of the penis.
6. During intercourse, make sure the condom stays in place and does not slip off.
7. After ejaculation and before the penis becomes flaccid, hold the condom at the base and carefully withdraw the penis.
8. Dispose of the used condom in a proper manner.

4. When to use HCPCS code A4267

HCPCS code A4267 should be used when billing for the provision of a male condom. It is typically used in the context of family planning services, sexual health clinics, or other healthcare settings where contraception and STI prevention are addressed. This code is not applicable for emergency situations or cases where immediate medical attention is required.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A4267, healthcare providers should ensure that the following documentation requirements are met:

• Clearly indicate the quantity of male condoms provided.
• Include the date of service and the patient’s identifying information.
• Submit the claim with the appropriate diagnosis codes to support the medical necessity of the contraceptive supply.

6. Historical Information and Code Maintenance

HCPCS code A4267 was added to the Healthcare Common Procedure Coding System on January 01, 2003. Since its addition, there have been no maintenance actions taken for this code, as indicated by the action code N, which means no maintenance for this code.

7. Medicare and Insurance Coverage

HCPCS code A4267 is not payable by Medicare, as indicated by the coverage code I. This means that Medicare does not provide reimbursement for male condoms. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. The multiple pricing indicator code is 9, which means that the value for this code is not established.

8. Examples

Here are five examples of when HCPCS code A4267 should be billed:

1. A patient visits a family planning clinic and is provided with a male condom as part of their contraceptive counseling.
2. A healthcare provider gives a presentation on sexual health and distributes male condoms to the attendees.
3. A patient requests a prescription for male condoms from their primary care physician.
4. A sexual health clinic provides male condoms to individuals as part of an outreach program.
5. A college health center offers free male condoms to students as a part of their sexual health services.