Question 1

What is HCPCS code S4042?

Accepted Answer

HCPCS code S4042 is "Ovulation mgmt per cycle". Management of ovulation induction (interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle

Question 2

What category is S4042 in?

Accepted Answer

S4042 belongs to HCPCS Category S (Temporary National Codes (Non-Medicare)).

Question 3

When should I use HCPCS code S4042?

Accepted Answer

Use S4042 when billing for ovulation mgmt per cycle. 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 S4042 covered by Medicare?

Accepted Answer

Coverage for S4042 (Ovulation mgmt per cycle) 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 S4042?

Accepted Answer

Documentation for S4042 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).