2025 HCPCS code A4562

HCPCS code A4562 represents the supply of a reusable, non-rubber pessary.

Adhere to all HCPCS coding guidelines and payer-specific requirements.Appropriate documentation is crucial for accurate coding and reimbursement.

Modifiers may be applicable depending on the circumstances of service, such as the place of service or the type of provider involved in the supply of the pessary. Consult current modifier guidelines.

Medical necessity for a pessary is established when a patient presents with symptoms and/or findings indicative of pelvic organ prolapse or other conditions where the use of a pessary is medically appropriate for symptom management or support. Documentation must support the clinical indication for its use.Payers may have specific medical necessity criteria.

The clinical responsibility lies with the physician or healthcare provider who orders and/or supplies the pessary.This may vary based on the practice setting and billing practices.

IMPORTANT A4561 (Pessary, rubber, any type) is an alternative code for a rubber pessary. CPT codes 57160 (Fitting and insertion of pessary) and potentially others may be used for the procedure of inserting the pessary.

In simple words: This code is for the cost of a reusable, non-rubber device that's placed in the vagina to support the uterus or bladder.It's often used to help with problems caused by weakened pelvic floor muscles.

HCPCS code A4562 reports the supply of any type of reusable, non-rubber pessary.A pessary is a removable medical device inserted into the vagina to provide structural support to pelvic organs, often used in cases of pelvic organ prolapse to alleviate symptoms like discomfort, incontinence, or bowel issues.This code is for the supply of the pessary itself, not the fitting or insertion procedure.

Example 1: A 60-year-old female patient presents with symptoms of pelvic organ prolapse.Following a physical examination and confirmation of prolapse, the physician orders a non-rubber pessary for symptom management. Code A4562 is used to bill for the supply of the pessary., A 72-year-old female post-hysterectomy patient experiences vaginal vault prolapse and reports urinary incontinence.Her physician decides to manage her condition with a non-rubber pessary. Code A4562 is used to bill for the supply of the pessary to her., A 45-year-old female patient with a history of multiple vaginal deliveries and pelvic floor muscle weakness is experiencing symptoms of uterine prolapse.Her physician orders a non-rubber pessary as a conservative management option. Code A4562 is used to bill for the pessary supply.

Documentation should include the patient's medical history, physical examination findings confirming pelvic organ prolapse or other indication for pessary use, the type of pessary supplied (non-rubber), and the physician's order for the device. Any relevant images or other supporting diagnostic data are also beneficial for accurate billing and proper medical record keeping.

** The billing of code A4562 is separate from the codes for the fitting and insertion of the pessary (CPT 57160).Ensure proper documentation and adherence to all relevant coding guidelines for accurate reimbursement. The reimbursement may vary depending on the payer and place of service.

  • Payment Status: Active
  • Modifier TC rule: A Technical Component (TC) modifier is not typically applicable to this code as it represents the supply of the device, not a procedure.
  • Fee Schedule : Fee schedules vary by payer and location.Refer to the appropriate payer's fee schedule for the current payment rates. Historical fee data can be obtained from the payer or relevant billing databases.
  • Specialties:Urogynecology, Obstetrics and Gynecology
  • Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center
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