A4264 HCPCS code: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
A4264 is the HCPCS Level II code for permanent implantable contraceptive intratubal occlusion device(s) and delivery system. Its Medicare coverage code is I (Not payable by Medicare): Medicare does not pay separately under this code; another code applies.
Code details
| Field | Value |
|---|---|
| Section | A codes — Transportation, medical/surgical supplies and miscellaneous |
| Coverage code | I — Not payable by Medicare |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Z2 |
| Added | 2010-01-01 |
| Last action effective | 2010-01-01 |
Related codes Medicare does pay
Medicare does not pay under A4264. These codes in the same A42 family carry a current DMEPOS fee:
- A4216 — Sterile water, saline and/or dextrose, diluent/flush, 10 ml: $0.53–$0.99
- A4217 — Sterile water/saline, 500 ml: $2.18–$4.93
What changed for A4264
- 2010-01-01: A4264 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code A4264?
A4264 is the HCPCS Level II code for permanent implantable contraceptive intratubal occlusion device(s) and delivery system. Short descriptor: "Intratubal occlusion device".
Does Medicare cover A4264?
Coverage code I — Not payable by Medicare. Medicare does not pay separately under this code; another code applies.
Which related codes does Medicare pay instead of A4264?
Codes in the same A42 family with a DMEPOS fee include A4216 ($0.53–$0.99), A4217 ($2.18–$4.93). Check the item matches the code's descriptor before billing.
Related A42 codes
- A4206 — Syringe with needle, sterile, 1 cc or less, each
- A4207 — Syringe with needle, sterile 2 cc, each
- A4208 — Syringe with needle, sterile 3 cc, each
- A4209 — Syringe with needle, sterile 5 cc or greater, each
- A4210 — Needle-free injection device, each
- A4211 — Supplies for self-administered injections
- A4212 — Non-coring needle or stylet with or without catheter
- A4213 — Syringe, sterile, 20 cc or greater, each
- A4215 — Needle, sterile, any size, each
- A4216 — Sterile water, saline and/or dextrose, diluent/flush, 10 ml ($0.53–$0.99)
- A4217 — Sterile water/saline, 500 ml ($2.18–$4.93)
- A4218 — Sterile saline or water, metered dose dispenser, 10 ml
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Next steps
- Run a reimbursement report for a device billed under A4264
- Watch A4264 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for A4264
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.