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

CMS doesn’t publish an office rate for A4264 in Maine.

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

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 in Maine

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.

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.

A4264 compared with similar codes

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.

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