A4264 – Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
HCPCS Level II code · A codes: Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental
HCPCS codeA4264
- Long description
- Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
- Short description
- Intratubal occlusion device
- Pricing indicator
00Not separately priced by Part B (bundled, not covered or Part A only)- Medicare coverage
INot payable by Medicare- BETOS category
Z2Undefined codes- Added
- January 1, 2010
- Last change
- January 1, 2010 – No change
Frequently asked questions
What is HCPCS code A4264?
A4264 is a HCPCS Level II code for permanent implantable contraceptive intratubal occlusion device(s) and delivery system.
Does Medicare cover A4264?
The HCPCS file lists coverage code I: Not payable by Medicare. Coverage and payment also depend on local coverage determinations and the patient’s plan.
Nearby A codes
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- A4259 – Lancets, per box of 100
- A4261 – Cervical cap for contraceptive use
- A4262 – Temporary, absorbable lacrimal duct implant, each
- A4263 – Permanent, long term, non-dissolvable lacrimal duct implant, each
- A4265 – Paraffin, per pound
- A4266 – Diaphragm for contraceptive use
- A4267 – Contraceptive supply, condom, male, each
- A4268 – Contraceptive supply, condom, female, each
- A4269 – Contraceptive supply, spermicide (e.g., foam, gel), each
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Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.