HCPCS code A4268: Female condom, per condom2026 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 A4268 covers

A4268 represents one female condom, also called an internal condom: a barrier contraceptive product placed inside the vagina for use during intercourse to prevent pregnancy. The code identifies the supply itself, rather than counseling or a contraceptive procedure. Its each-item basis means one unit represents one individual condom supplied.

For Medicare, A4268 has physician fee schedule status I, meaning it is not valid for Medicare reporting and Medicare uses a different code to report and pay for this service. CMS also classifies it as not payable and not separately priced under Medicare Part B. Do not submit A4268 as a payable Medicare line. The item is distinct from the male condom (A4267), diaphragm (A4266), and cervical cap (A4261) supply codes.

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 A4268 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

A4268 rates by state

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

How the A4268 rate is calculated

Each of A4268’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 A4268

A4268 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.

A4268 compared with similar codes

How to choose

A4267Male condomEach

Choose A4268 for a female, or internal, condom; A4267 identifies a male condom.

A4266DiaphragmContraceptive use

A4266 identifies a diaphragm, not a female condom. The products are different barrier contraceptives.

A4261Cervical capContraceptive use

A4261 identifies a cervical cap. A4268 identifies a separate product, the female condom.

Codes related to A4268

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