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

CMS doesn’t publish an office rate for A4261 in California.

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

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 in California

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

29 of 29 payment localities

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.

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.

A4261 compared with similar codes

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.

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