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HCPCS code A4264: Contraceptive implant, permanent intratubal2026 Medicare rate & RVUs

A4264 identifies the permanent implantable device and delivery system used for hysteroscopic occlusion of the fallopian tubes for contraception.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · A4264

Contraceptive implant, permanent intratubal

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 A4264 →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 A4264 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 A4264 covers

A4264 identifies a permanent implantable contraceptive device and delivery system used to occlude the fallopian tubes. The device is placed hysteroscopically through the cervix and uterus, with the implants positioned in the tubes. Gynecologists may report the device with the hysteroscopic service represented by CPT 58565. It differs from barrier methods such as a cervical cap, diaphragm, or condom, which do not permanently occlude the tubes.

For Medicare, A4264 has physician fee schedule status I: it is not valid for Medicare, which uses a different code to report and pay for the service. CMS also classifies A4264 as not separately priced under Medicare Part B, and its HCPCS coverage code marks it not payable by Medicare. A4264 represents the implantable device or devices and delivery system, not a medication. CPT 58565 identifies the associated hysteroscopic placement procedure.

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 A4264 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

A4264 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

A4264 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
A4264 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 A4264 rate is calculated

Each of A4264’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 · A4264

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 A4264

A4264 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 · A4264

Which rate does Medicare pay?

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

POS 11 · non-facility rate · national

—

A4264 isn’t priced in this setting.

A4264 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • A4264

    Contraceptive implant, permanent intratubal0 wRVU

    Not priced

  • 58565

    Hysteroscopic sterilization, bilateral tubal implants6.94 wRVU

    $1,582.53

  • A4261

    Cervical cap, contraceptive use0 wRVU

    Not priced

  • A4266

    Diaphragm, contraceptive use0 wRVU

    Not priced

  • A4267

    Male condom, each0 wRVU

    Not priced

How to choose

58565Hysteroscopic sterilizationBilateral tubal implants
A4264 identifies the implant device and delivery system; CPT 58565 identifies the hysteroscopic procedure used to place permanent implants for tubal occlusion.
A4261Cervical capContraceptive use
A4261 identifies a cervical cap, a barrier contraceptive. A4264 identifies a permanent intratubal implant and delivery system.
A4266DiaphragmContraceptive use
A4266 identifies a diaphragm used as a barrier contraceptive; A4264 is for permanent tubal occlusion.
A4267Male condomEach
A4267 identifies a male condom, a barrier contraceptive; A4264 identifies a permanent intratubal device and delivery system.

Codes related to A4264

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

Codes related to A4264
CodeHow it relatesNational office range
Often billed with
58565Hysteroscopic sterilization, bilateral tubal implantsIdentifies the hysteroscopic placement procedure for permanent tubal occlusion implants.$1,378.06–$2,168.14
Used instead
A4261Cervical cap, contraceptive useA cervical cap is a nonpermanent barrier contraceptive option.No office rate
A4266Diaphragm, contraceptive useA diaphragm is a nonpermanent barrier contraceptive option.No office rate
A4267Male condom, eachA male condom is a barrier contraceptive option rather than permanent sterilization.No office rate
A4268Female condom, per condomA female condom is a barrier contraceptive option rather than permanent sterilization.No office rate

A4264 billing questions

What does A4264 identify?

It identifies a permanent implantable contraceptive device and its delivery system for occluding the fallopian tubes.

How is A4264 different from CPT 58565?

A4264 identifies the device and delivery system. CPT 58565 identifies the hysteroscopic placement procedure.

Does Medicare pay for A4264?

No. A4264 is not valid for Medicare under status I, and its HCPCS coverage code marks it not payable by Medicare.

Is A4264 separately priced under Medicare Part B?

No. CMS classifies A4264 as not separately priced under Medicare Part B.

Is A4264 the same as a cervical cap or diaphragm?

No. A4264 identifies a permanent intratubal device; a cervical cap and diaphragm are barrier contraceptives.

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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