2025 HCPCS code A4266
(Active) Effective Date: N/A Revision Date: N/A Medical Supplies - Other Supplies Including Diabetes Supplies and Contraceptives Medical and Surgical Supplies Feed
Supply of a diaphragm for contraceptive use.
Medical necessity for A4266 is established when the patient presents with a clinical need for contraception.The provider should document the patient's request for a diaphragm, along with a discussion of the benefits, risks, and alternatives, to justify the medical necessity for this supply.
The clinical responsibility rests with the healthcare provider who supplies the diaphragm.This involves ensuring proper patient education on correct usage and potential risks.
- Medical and Surgical Supplies
- A4206-A8004 (Other Supplies Including Diabetes Supplies and Contraceptives)
In simple words: This code covers the cost of a diaphragm, a birth control device a woman inserts into her vagina to prevent pregnancy.
HCPCS code A4266 represents the supply of a diaphragm, a dome-shaped device made of rubber or plastic, used as a contraceptive method in women.The diaphragm is inserted into the vagina to cover the cervix, preventing sperm from reaching and fertilizing an egg.It's often used with spermicide to increase effectiveness. This code does not include fitting or insertion services.
Example 1: A 25-year-old female patient requests a diaphragm as a contraceptive method. The physician provides counseling and education regarding the device. The diaphragm is dispensed to the patient. Code A4266 is billed for the supply of the diaphragm., A family planning clinic provides diaphragms to several patients.Appropriate documentation, including patient education and informed consent, are recorded in their charts for each patient receiving a diaphragm. Code A4266 is billed for each diaphragm supplied., A 30-year-old female patient visits her gynecologist for a follow-up appointment. During the visit, she receives a new diaphragm as the previous one has expired.The physician provides a refresher on correct usage and answers the patient's questions. Code A4266 is billed for the replacement diaphragm.
* Patient demographics and insurance information.* Documentation of the physician's discussion with the patient on the correct use of the diaphragm.* Informed consent signed by the patient.* Documentation that the patient received education on the use and risks associated with diaphragm use.* Appropriate medical record notes justifying the medical necessity for the diaphragm.
** Diaphragms are typically replaced every 2 years or if damaged.The spermicide used with the diaphragm is billed separately using code A4269.
- Payment Status: Active (coverage varies by payer)
- Specialties:Obstetrics and Gynecology, Family Medicine
- Place of Service:Office, Clinic