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2025 HCPCS code A4268

Supply of one female condom for contraception and STD prevention.

HCPCS coding guidelines should be followed for accurate reporting.Confirm payer-specific requirements for coverage and billing.

Modifiers may apply depending on the circumstances of the service.Consult your payer’s specific guidelines.

Medical necessity would be established by the patient's need for contraception and/or STI prevention.The clinical decision to provide the female condom should be documented in the patient's chart.

The clinical responsibility is the provision of the female condom to the patient.Counseling regarding use and safe sex practices may also be the responsibility of the clinician.

IMPORTANT:A4267 (Male Condom)

In simple words: This code is for billing the supply of one female condom.A female condom is a type of birth control that also helps protect against sexually transmitted infections.

This HCPCS code, A4268, reports the supply of a single female condom.The female condom is a thin, moist sheath inserted into the vagina during sexual intercourse to act as a barrier method of contraception and to help prevent the transmission of sexually transmitted infections (STIs) such as HIV, Hepatitis B, Herpes, and HPV.The code represents the supply of one female condom; multiple condoms supplied should be billed with multiple units.

Example 1: A family planning clinic provides a female condom to a patient as part of a comprehensive reproductive health visit., A physician provides a female condom to a patient during a routine gynecological exam, as part of a discussion about STI prevention and contraception., A sexual health clinic provides a female condom to a patient who is at high risk for STIs.

Documentation should include the date of service, the number of condoms provided, patient's age, relevant medical history, and a note indicating the reason for supply (e.g., contraception, STI prevention).

** Medicare does not cover this code. Coverage by other payers varies.Always verify coverage 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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