HCPCS code A4261: Cervical cap, contraceptive use2026 Medicare rate & RVUs in Massachusetts
A reusable barrier device placed over the cervix for contraception, reported as a supply when furnished for contraceptive use.
CMS doesn’t publish an office rate for A4261 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | Unavailable |
| Rest of Massachusetts | Unavailable | Unavailable |
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
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
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A4261 isn’t priced in this setting.
A4261 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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