Summary & Overview
HCPCS Level II A4268: Contraceptive Supply, Female Condom
HCPCS Level II code A4268 denotes a single female condom supplied for contraceptive and barrier protection purposes. Nationally, supply codes like A4268 are important for tracking access to contraceptive devices, family planning services, and public health distribution programs. This code applies to outpatient and community-based distribution settings where barrier contraception is furnished.
The analysis covers common national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, billing considerations relevant to supply items, and clinical context for use of female condoms in contraceptive care. The publication summarizes benchmarks for supply utilization, typical sites of service for dispensing, and policy topics that affect coverage and coding for contraceptive supplies.
This resource addresses billing clarity for supply-only encounters, expected place-of-service settings, and areas where payers may vary in coverage. Data not available in the input for specific modifiers, taxonomies, ICD-10 pairings, or related codes is noted elsewhere in the document.
Billing Code Overview
HCPCS Level II code A4268 represents a contraceptive supply: female condom, billed per each. This code is used for supply items provided to patients for the purpose of contraception and barrier protection.
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Service type: Contraceptive supply (female condom)
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Typical site of service: Outpatient clinic, family planning clinic, sexual health clinic, pharmacy distribution, or community health setting where contraceptive supplies are dispensed
Clinical & Coding Specifications
Clinical Context
A sexually active adult female patient presents to a primary care clinic, family planning clinic, or community health center requesting barrier contraception. The clinician reviews contraceptive options, documents informed consent and counseling, and provides a supply of female condoms for immediate use. Typical workflow includes patient check-in, medication/allergy verification, brief sexual health counseling, screening for contraindications, selection and dispensing of the item coded as A4268, recording lot number and quantity in the medical record, and updating preventive services or family planning notes. The typical site of service is an outpatient ambulatory clinic, community health center, public health department, or retail clinic where contraceptive supplies are distributed free or by prescription.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier/Unspecified | Use when no specific modifier applies and the claim requires the base HCPCS code only. |
22 | Increased procedural services | Rarely applicable; use if unusually extensive counseling or patient education is documented beyond typical dispensing. |