Question 1

What is HCPCS code A4261?

Accepted Answer

HCPCS code A4261 is "Cervical cap contraceptive". Cervical cap for contraceptive use

Question 2

What category is A4261 in?

Accepted Answer

A4261 belongs to HCPCS Category A (Transportation, Medical/Surgical Supplies, Miscellaneous).

Question 3

When should I use HCPCS code A4261?

Accepted Answer

Use A4261 when billing for cervical cap contraceptive. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is A4261 covered by Medicare?

Accepted Answer

Coverage for A4261 (Cervical cap contraceptive) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for A4261?

Accepted Answer

Documentation for A4261 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).