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2025 HCPCS code A4269

Supply of one foam or gel spermicide applicator.

Follow all applicable HCPCS coding guidelines.Ensure proper documentation supports the medical necessity and quantity of applicators billed.

Modifiers may apply depending on the circumstances of service. Consult official HCPCS guidelines.

Medical necessity is determined by the provider's clinical judgment in the context of the patient's family planning needs and overall reproductive health.The patient's informed consent and understanding of spermicide use should be documented.

The clinical responsibility involves providing the patient with a spermicide applicator as part of a contraceptive strategy.Patient education regarding proper use and potential interactions with other medications should be included.

In simple words: This code is for one applicator used with a spermicide, a type of birth control that stops sperm from moving and reaching an egg.It’s a separate charge for each applicator given to the patient.

This HCPCS code, A4269, reports the supply of a single applicator for foam or gel spermicide.Spermicides are chemical contraceptives that prevent pregnancy by immobilizing sperm. The code represents each individual applicator supplied.

Example 1: A 25-year-old female patient presents for a routine gynecological visit.She requests spermicide applicators as part of her birth control plan.One applicator is dispensed., A family planning clinic provides a 30-year-old patient with several spermicide applicators along with a diaphragm fitting and educational materials. The claim includes individual charges for each applicator supplied., A patient receives a prescription for spermicide and applicators from their physician. The pharmacy dispenses the spermicide and bills for the applicators separately using this HCPCS code.

* Documentation of the patient's request for spermicide applicators.* Documentation of the number of applicators provided.* Patient education and counseling notes concerning the use of spermicide and its effectiveness.

** Medicare does not cover this code. Coverage by other payers may vary.Always check with the specific payer for their coverage policies.

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

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