Summary & Overview
HCPCS A4264: Permanent Intratubal Contraceptive Device and Delivery System
HCPCS Level II code A4264 represents a permanent implantable intratubal occlusion device and its delivery system used for female sterilization. Nationally, this code is relevant for payer coverage decisions, surgical supply categorization, and reporting of permanent contraceptive services. It is most commonly billed for outpatient or ambulatory surgical procedures during which a device is placed to achieve permanent tubal occlusion.
Key payers covered include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a concise overview of how A4264 is used in clinical and billing workflows, typical sites of service, and the clinical context for permanent contraception. Readers will find benchmarks on common billing practices, an outline of policy and coding considerations, and clinical context about the procedure and device type. Information on common modifiers, associated taxonomies, ICD-10 diagnoses, and related codes is noted where available; where input data is missing, the publication indicates that data are not available in the input.
This summary is intended for clinicians, billing professionals, and policy analysts seeking a national-level reference for HCPCS Level II code A4264 and its role in documenting permanent contraceptive device placement.
Billing Code Overview
HCPCS Level II code A4264 designates a permanent implantable contraceptive intratubal occlusion device(s) and delivery system. This code covers the device and associated delivery system used for permanent female sterilization via intratubal occlusion.
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Service type: Permanent implantable contraceptive device placement and delivery system
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Typical site of service: Outpatient surgical setting or ambulatory surgery center where permanent contraceptive implantation is performed
Clinical & Coding Specifications
Clinical Context
A 32-year-old female desiring permanent contraception presents to an outpatient ambulatory surgical center. After counseling and informed consent, she undergoes a scheduled transcervical intratubal occlusion device placement using a permanent implantable intratubal occlusion device and delivery system. The procedure is typically performed under conscious sedation or monitored anesthesia care with ultrasound or hysteroscopic guidance to access the tubal ostia. The clinical workflow includes pre-procedure pregnancy testing and review of contraindications, placement of the device(s) into one or both fallopian tubes with fluoroscopic or hysteroscopic confirmation of correct positioning, brief recovery for post-procedure monitoring, and discharge with instructions for follow-up and alternative contraception until occlusion is confirmed. Typical site of service is an outpatient ambulatory surgical center or hospital outpatient department. The procedure is intended for women who have completed childbearing and seek permanent sterilization via intratubal occlusion.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / standard billing | Use when no special modifier applies and service is billed as usual. |
22 |