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Updates to Clinic Dispensing of Internal (Female) Condoms

October 25, 2019

Effective for dates of service on or after May 1, 2019, HCPCS code A4268 (contraceptive supply, condom, female, each) may be billed separately at the rate of $2.50 per unit for the Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) programs. The clinic dispensing fee is 10 percent of the subtotal billed. In addition, the dispensing limit for code A4268 is up to 12 units per claim and up to 24 units in a 90-day period.

An Erroneous Payment Correction (EPC) will reprocess affected claims. No action is required of providers.

The manual replacement pages reflecting this policy will be published in a future Medi-Cal Update and Family PACT Update.