How To Use HCPCS Code A9268

HCPCS code A9268 describes a programmer for a transient, orally ingested capsule. This code is used to identify the specific device used to program a capsule that is designed to be ingested orally. In this article, we will explore the details of HCPCS code A9268, including its official description, procedure, when to use it, billing guidelines, historical information, Medicare and insurance coverage, and provide examples of when this code should be billed.

1. What is HCPCS A9268?

HCPCS code A9268 is used to identify a programmer for a transient, orally ingested capsule. This code specifically refers to the device used to program a capsule that is intended to be ingested orally. It is important to note that this code is not applicable for other types of programmers or capsules.

2. Official Description

The official description of HCPCS code A9268 is “Programmer for transient, orally ingested capsule.” The short description for this code is “Programmer orally ingest cap.”

3. Procedure

1. The provider begins by ensuring that the patient is eligible and suitable for the use of a transient, orally ingested capsule.
2. The provider then prepares the capsule for ingestion, following the specific instructions provided by the manufacturer.
3. Once the capsule is ready, the provider uses the programmer device (HCPCS code A9268) to program the capsule with the necessary information or instructions.
4. The programmed capsule is then given to the patient for ingestion.

4. When to use HCPCS code A9268

HCPCS code A9268 should be used when a programmer device is used to program a transient, orally ingested capsule. It is important to ensure that the specific requirements for using this code are met, including the eligibility criteria and guidelines set forth by the payer or insurer.

5. Billing Guidelines and Documentation Requirements

When billing for HCPCS code A9268, healthcare providers should ensure that the necessary documentation is in place to support the use of this code. This may include documentation of the patient’s eligibility for the use of a transient, orally ingested capsule, as well as any relevant medical records or prescriptions. Providers should also follow the billing guidelines set forth by the payer or insurer to ensure accurate and timely reimbursement.

6. Historical Information and Code Maintenance

HCPCS code A9268 was added to the Healthcare Common Procedure Coding System on October 01, 2023. As of the effective date, 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 A9268 is classified as non-covered by Medicare statute, meaning that it is not payable by Medicare. The pricing indicator code for this code is 00, which indicates that the service is not separately priced by Part B. It is important to check with other insurers or payers to determine their coverage and pricing policies for HCPCS code A9268.

8. Examples

Here are five examples of when HCPCS code A9268 should be billed:

1. A patient with a specific medical condition requires a transient, orally ingested capsule for targeted drug delivery. The capsule needs to be programmed using the A9268 device before ingestion.
2. A clinical trial participant is enrolled in a study that involves the use of a transient, orally ingested capsule. The capsule needs to be programmed using the A9268 device as part of the trial protocol.
3. A patient is prescribed a transient, orally ingested capsule for diagnostic purposes. The capsule needs to be programmed using the A9268 device to ensure accurate data collection during the diagnostic process.
4. A healthcare facility offers a specialized treatment program that includes the use of transient, orally ingested capsules. The capsules are programmed using the A9268 device to tailor the treatment to each patient’s specific needs.
5. A research institution is conducting a study on the effectiveness of transient, orally ingested capsules for a particular medical condition. The capsules used in the study are programmed using the A9268 device to ensure consistency and accuracy of the data collected.