A4261 — Cervical cap for contraceptive use
A4261 is a HCPCS Level II code for cervical cap for contraceptive use. 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: Non-covered by statute
Excluded from coverage by the Social Security Act itself, not by a policy decision. No documentation and no appeal changes this one — an ABN is the relevant conversation.
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 statusN
Non-covered service. Medicare does not cover it.
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 A4261 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 A4261
- Long descriptor
- Cervical cap for contraceptive use
- Short descriptor
- Cervical cap contraceptive
- Added
- January 1, 1999
- 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 A4261
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If A4261 is not quite right, the correct code is very often within a few positions of it.
- A4250Urine test or reagent strips or tablets (100 tablets or strips)
- A4252Blood ketone test or reagent strip, each
- A4253Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips
- 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
- A4262Temporary, absorbable lacrimal duct implant, each
- A4263Permanent, long term, non-dissolvable lacrimal duct implant, each
- A4264Permanent implantable contraceptive intratubal occlusion device(s) and delivery system
- 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
Questions about A4261
What is HCPCS code A4261?
A4261 is a HCPCS Level II code for cervical cap for contraceptive use. It sits in the Transportation, Medical & Surgical Supplies, Administrative section.
Does Medicare cover A4261?
The CMS HCPCS file marks A4261 as "Non-covered by statute". Excluded from coverage by the Social Security Act itself, not by a policy decision. No documentation and no appeal changes this one — an ABN is the relevant conversation.
How is A4261 paid under the physician fee schedule?
A4261 carries PFS status code N. Non-covered service. Medicare does not cover it.