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2025 HCPCS code A4261

Supply of a cervical cap for contraception.

Follow HCPCS coding guidelines. Confirm coverage with the payer.

Medical necessity is established based on the patient's request and the physician's determination of the suitability of the cervical cap as a birth control option for the patient. This must be documented along with any patient counseling and education.

The clinical responsibility involves providing the patient with a cervical cap for contraceptive purposes, ensuring proper fitting and education on its use.

In simple words: This code covers the cost of a cervical cap, a small cup-shaped device used by women to prevent pregnancy.It's placed over the cervix to block sperm.

HCPCS code A4261 reports the supply of a cervical cap used as a barrier method of contraception.The cervical cap is a silicone cap that fits over the cervix, preventing sperm from reaching the egg.It's often used with spermicide.

Example 1: A 25-year-old female patient requests a cervical cap as a birth control method. The physician provides the cervical cap and educates the patient on proper insertion and use., A 30-year-old female patient, already using a cervical cap, needs a replacement. The physician supplies the replacement cap and confirms proper fitting., During a routine gynecological check-up, a 28-year-old female patient discusses birth control options. The physician recommends a cervical cap and supplies one after confirming its suitability.

Patient's medical history, including relevant allergies and contraindications; Documentation of the fitting and education provided to the patient on the proper use of the cervical cap; Documentation of the type and quantity of cervical cap supplied.

** Medicare does not typically cover this code.Third-party payer coverage varies; check with the specific payer before billing.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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