Summary & Overview
HCPCS A4267: Contraceptive Supply, Male Condom, Each
HCPCS Level II code A4267 represents a single unit of male condom dispensed as a contraceptive supply. As a unit-level supply code for barrier contraception, it plays a role in family planning programs, preventive care distribution, and community sexual health services. Nationally, supplies coded with A4267 are used in diverse outpatient and retail settings where single condoms are provided to patients, often as part of public health distribution or clinic-based prevention programs.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what this code denotes, its typical clinical and service context, and the payer landscape relevant to supply-level contraceptive billing. The publication outlines benchmarks and policy-relevant considerations for coding and coverage of contraceptive supplies, summarizes common modifiers used with HCPCS supply codes, and provides clinical context for when single-unit condom dispensing is billed.
This summary is national in scope and intended for billing professionals, clinic administrators, and policy analysts seeking a clear, compact reference to HCPCS Level II code A4267 and its role in contraceptive supply services.
Billing Code Overview
HCPCS Level II code A4267 describes contraceptive supply, condom, male, each. The service type is contraceptive supply distribution, typically provided as a single over-the-counter supply item. The typical site of service is outpatient retail or community health settings, including clinics, family planning centers, and pharmacies where individual condom units are dispensed.
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Clinical & Coding Specifications
Clinical Context
A patient visits a primary care clinic, sexual health clinic, or community health center requesting barrier contraception. The encounter is an in-person supply issuance where the clinician or nurse documents counseling on condom use, verifies patient identity and consent, and provides one or more packaged male condoms coded as A4267 (contraceptive supply, condom, male, each). Typical workflow: patient presents for routine preventive care, sexually transmitted infection screening, or family planning; triage obtains vitals and reason for visit; clinician addresses contraceptive needs, reviews correct condom use and storage, screens for allergy to latex and offers alternatives if needed, and documents quantity dispensed. The item is commonly dispensed at point of care without a separate procedural service; counseling may be billed separately if eligible under payer policy. Typical site of service: outpatient clinic, public health clinic, family planning clinic, or community outreach setting. A realistic scenario: a 22-year-old sexually active patient attends a walk-in sexual health visit requesting condoms after STI screening; the nurse provides three A4267 units, documents counseling, and records the dispensing in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — Standard service |