Summary & Overview
HCPCS Level II A4266: Diaphragm for Contraceptive Use
HCPCS Level II code A4266 denotes the supply of a diaphragm for contraceptive use, a nonhormonal barrier method used in family planning and reproductive health services. Nationally, this code is relevant for outpatient reproductive health care, preventive services, and contraceptive coverage policies. It matters because device coverage rules and patient cost-sharing vary across commercial plans and Medicare, affecting access to this contraceptive option.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national perspective on how A4266 is classified and utilized in claims, typical service settings, and which payers commonly process claims for barrier contraceptive devices. The publication outlines payer coverage patterns, typical billing practice for outpatient contraceptive supplies, and clinical context around nonhormonal contraception.
This summary prepares clinicians, billing professionals, and policy analysts to understand where A4266 fits within reproductive health billing, what to expect from major national payers, and which operational topics (benchmarks, payer policy language, and clinical context) are covered in the full publication. Data not available in the input is noted where relevant.
Billing Code Overview
HCPCS Level II code A4266 describes a diaphragm for contraceptive use. This code represents the supply of a barrier contraceptive device intended for patient use to prevent pregnancy.
Service Type: Contraceptive device supply
Typical Site of Service: Outpatient clinic or office setting, including family planning clinics and outpatient gynecology visits.
Clinical & Coding Specifications
Clinical Context
A typical patient is a reproductive-age cisgender woman seeking non-hormonal contraception or evaluation for device fit after childbirth or pelvic surgery. The patient presents to an outpatient women’s health clinic or family planning clinic for diaphragm fitting, instruction, and provision. The visit is usually scheduled as a preventive or contraceptive service; the clinician (gynecologist, family medicine physician, nurse practitioner, or certified nurse-midwife) reviews medical history, performs a pelvic exam to confirm uterine position and vaginal anatomy, selects appropriate diaphragm size, demonstrates insertion and removal, counsels on concurrent spermicide use and when to replace the device, and documents informed consent and device details in the chart. Typical site of service is an outpatient clinic or ambulatory surgical center when performed in conjunction with another minor procedure. The diaphragm device itself is supplied to the patient at the visit and coded as durable medical equipment with billing code A4266 for a diaphragm for contraceptive use.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier. | Use when no modifier applies and standard billing is appropriate. |