A4264 – Permanent implantable contraceptive intratubal occlusion device(s) and delivery system

HCPCS Level II code · A codes: Transportation, Medical & Surgical Supplies, Miscellaneous & Experimental

Active code Not payable by Medicare

HCPCS codeA4264
Long description
Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
Short description
Intratubal occlusion device
Pricing indicator
00 Not separately priced by Part B (bundled, not covered or Part A only)
Medicare coverage
I Not payable by Medicare
BETOS category
Z2 Undefined 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

Source: CMS HCPCS Level II quarterly file, October 2026. Reference only – check payer policy before billing.