A4264 — Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
A4264 is a HCPCS Level II code for permanent implantable contraceptive intratubal occlusion device(s) and delivery system. It belongs to the Transportation, Medical & Surgical Supplies, Administrative section. Medicare does not pay it — see the coverage note below before you bill it.
Medicare coverage: Not payable by Medicare
Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusI
Not valid for Medicare purposes. Medicare uses another code.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of A4264 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for A4264
- Long descriptor
- Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
- Short descriptor
- Intratubal occlusion device
- Added
- January 1, 2010
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to A4264
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4264 is not quite right, the correct code is very often within a few positions of it.
- A4255Platforms for home blood glucose monitor, 50 per box
- A4256Normal, low and high calibrator solution / chips
- A4257Replacement lens shield cartridge for use with laser skin piercing device, each
- A4258Spring-powered device for lancet, each
- A4259Lancets, per box of 100
- A4261Cervical cap for contraceptive use
- A4262Temporary, absorbable lacrimal duct implant, each
- A4263Permanent, long term, non-dissolvable lacrimal duct implant, each
- A4265Paraffin, per pound
- A4266Diaphragm for contraceptive use
- A4267Contraceptive supply, condom, male, each
- A4268Contraceptive supply, condom, female, each
- A4269Contraceptive supply, spermicide (e.g., foam, gel), each
- A4270Disposable endoscope sheath, each
- A4271Integrated lancing and blood sample testing cartridges for home blood glucose monitor, per 50 tests
- A4280Adhesive skin support attachment for use with external breast prosthesis, each
Questions about A4264
What is HCPCS code A4264?
A4264 is a HCPCS Level II code for permanent implantable contraceptive intratubal occlusion device(s) and delivery system. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4264?
The CMS HCPCS file marks A4264 as "Not payable by Medicare". Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
How is A4264 paid under the physician fee schedule?
A4264 carries PFS status code I. Not valid for Medicare purposes. Medicare uses another code.