Summary & Overview
HCPCS A4562: Reusable Non-Rubber Pessary
HCPCS Level II code A4562 denotes a reusable, non-rubber pessary, a durable medical device used for pelvic organ support and management of pelvic organ prolapse. This code is nationally relevant because pessaries are a common non-surgical option in gynecologic care and are billed across multiple outpatient and durable medical equipment settings. Understanding coding and coverage for A4562 affects device provision, supply sourcing, and billing consistency.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, common modifier use, and clinical context for device use. The material outlines typical sites of service and the service type associated with the code, and explains where additional documentation or coding crosswalks may be needed. The report summarizes benchmarking and policy considerations relevant to billing this durable medical device and highlights areas where payers commonly require medical necessity documentation or supplier enrollment details.
This summary provides clinicians, billing staff, and policy analysts with a concise reference on HCPCS Level II code A4562, clarifying what the code represents, who commonly pays for the item, and what elements to review when submitting claims. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code A4562 describes a reusable, non-rubber pessary intended for gynecologic use. The item is a device provided to support pelvic organs and manage pelvic organ prolapse or related pelvic support conditions.
Service Type: Durable medical device (gynecologic support device)
Typical Site of Service: Outpatient clinic, physician office, or durable medical equipment supplier
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a postmenopausal woman presenting to a gynecology clinic with symptomatic pelvic organ prolapse (uterine or vaginal vault prolapse) or stress urinary incontinence who declines or is not a candidate for immediate surgical repair. The clinician evaluates pelvic support using physical exam (Valsalva, POP-Q) and discusses conservative management. A non-rubber, reusable pessary (A4562) is selected for fitting in the office. The workflow includes history and pelvic exam, measurement and selection of pessary size and type, insertion and patient education on use and self-care or scheduled follow-up for maintenance. The device may be provided at the visit or dispensed for home use. Typical site of service is an outpatient gynecology clinic, ambulatory surgery center for complex fittings, or durable medical equipment dispensing location when billed separately from provider services.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified | Not commonly used; reserved if no other modifier applies |
11 | Primary Procedure |