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HCPCS code A4261: Cervical cap, contraceptive use2026 Medicare rate & RVUs

A reusable barrier device placed over the cervix for contraception, reported as a supply when furnished for contraceptive use.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · A4261

Cervical cap, contraceptive use

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for A4261 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What A4261 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What A4261 covers

The cap is a small, reusable dome-shaped barrier that sits over the cervix inside the vagina; spermicide is generally used with it. It is a user-applied contraceptive supply, rather than an implant or procedure. A clinician in gynecologic or reproductive health care may explain placement and check fit, while A4261 identifies the cap itself.

Medicare lists A4261 with physician fee schedule status N, meaning it is not covered by Medicare by statute. The HCPCS pricing assignment says it is not separately priced by Medicare Part B. A4261 identifies the cap as a contraceptive item, not fitting or contraceptive counseling; those services are distinct from the supply described by this code.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where A4261 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

A4261 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

A4261 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
A4261 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the A4261 rate is calculated

Each of A4261’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · A4261

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for A4261

A4261 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · A4261

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

A4261 isn’t priced in this setting.

A4261 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • A4261

    Cervical cap, contraceptive use0 wRVU

    Not priced

  • A4266

    Diaphragm, contraceptive use0 wRVU

    Not priced

  • A4269

    Spermicide, each supply0 wRVU

    Not priced

  • A4264

    Contraceptive implant, permanent intratubal0 wRVU

    Not priced

How to choose

A4266DiaphragmContraceptive use
A4261 identifies a cap that covers the cervix; A4266 identifies a diaphragm, another type of contraceptive barrier.
A4269SpermicideEach supply
A4261 is the cervical cap device. A4269 is spermicide, which may be used with the cap.
A4264Contraceptive implantPermanent intratubal
A4261 is a barrier contraceptive device. A4264 identifies an intratubal occlusion device, a different form of contraception.

Codes related to A4261

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to A4261
CodeHow it relatesNational office range
Used instead
A4266Diaphragm, contraceptive useA contraceptive diaphragm is another vaginal barrier device, distinct from a cervical cap.No office rate
A4267Male condom, eachIdentifies a male condom, a different barrier method of contraception.No office rate
A4268Female condom, per condomIdentifies a female condom, a different barrier method of contraception.No office rate

A4261 billing questions

When should A4261 be used instead of A4266?

Use A4261 for a cervical cap that covers the cervix. A4266 identifies a contraceptive diaphragm, a different barrier device.

Does A4261 include fitting or contraceptive counseling?

A4261 identifies the cap supplied, not a clinician's fitting or counseling service. Any separately reported professional service must be coded according to the service performed.

Does Medicare cover the cervical cap?

No. Medicare classifies A4261 as not covered by statute, with physician fee schedule status N; it is also not separately priced under Medicare Part B.

Is A4261 the code for spermicide used with the cap?

No. A4261 identifies the cervical cap. A4269 identifies spermicide.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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