HCPCS code A4267: Male condom, each2026 Medicare rate & RVUs

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

What A4267 covers

This code identifies an individual male condom furnished as a contraceptive supply. Pharmacies, family planning clinics, and other suppliers may provide condoms for use as a barrier method of contraception. The code distinguishes this product from female condoms and other contraceptive supplies such as diaphragms and cervical caps.

A4267 has Medicare physician fee schedule status I, meaning it is not valid for Medicare and Medicare uses a different code to report and pay for the service. The A4267 code itself is not payable by Medicare and is not separately priced under Medicare Part B. One unit represents one condom, not a package quantity. It should not be submitted as a payable Medicare line.

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 A4267 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

A4267 rates by state

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

How the A4267 rate is calculated

Each of A4267’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 A4267

A4267 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.

A4267 compared with similar codes

How to choose

A4268Female condomPer condom

Use A4267 for a male condom and A4268 for a female condom. They identify different products, even though both are barrier contraceptives.

A4266DiaphragmContraceptive use

A4266 identifies a diaphragm, not a condom. Select A4267 only when the supplied item is a male condom.

A4261Cervical capContraceptive use

A4261 identifies a cervical cap. A4267 is specific to a male condom.

Codes related to A4267

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