2025 HCPCS code A4267
Contraceptive supply, condom, male, each.
Modifiers may be applicable depending on the circumstances of the service. For example, modifier FP may be used if the service is provided as part of a family planning program.
Medical necessity may be established based on the patient's need for contraception or STD prevention.
This code represents the provision of a male condom by a healthcare provider.It can be part of family planning services or STD prevention programs.The provider should counsel the patient on the proper use of condoms for effective contraception and STD prevention.
In simple words: This code is for a single male condom, used for birth control and protection against some sexually transmitted diseases.
This code represents the supply of a male condom, a thin cap or cover worn over the penis during sexual intercourse. It acts as a barrier method of contraception by preventing sperm from entering the vagina. It may also prevent the transmission of some sexually transmitted diseases (STDs) such as HIV, hepatitis B, herpes, and HPV.This code is for each male condom.
Example 1: A patient visits a family planning clinic and requests condoms as a method of birth control. The clinic provides a supply of male condoms, and the provider bills using A4267 for each condom supplied., A patient is treated for an STD at a public health clinic.As part of the treatment plan, the provider supplies male condoms to the patient for STD prevention and bills using A4267 for each condom supplied., A healthcare provider distributes male condoms at a community outreach event focusing on sexual health and HIV prevention. The provider may bill A4267 for each condom distributed, depending on the specific program and payer guidelines.
Documentation should include the number of condoms provided, date of service, and relevant diagnosis codes related to family planning or STD prevention.If provided as part of an STD treatment, documentation of the diagnosis and treatment plan should be included.
** Medicare does not cover this code. Third-party payer coverage may vary.Providers should verify coverage with the specific payer prior to billing.While condoms can reduce the risk of some STDs, they do not eliminate the risk entirely.
- Payment Status: Not covered by Medicare. Coverage by third-party payers may vary.
- Specialties:Family Medicine, Obstetrics and Gynecology, Urology, Internal Medicine, Infectious Disease, Public Health
- Place of Service:Office, Public Health Clinic, Family Planning Clinic, Outreach Site/Street, Federally Qualified Health Center, School, Homeless Shelter, Prison/Correctional Facility, Other Place of Service