Summary & Overview
HCPCS J1726: Hydroxyprogesterone Caproate (Makena) Injection, 10 mg
HCPCS Level II code J1726 denotes a 10 mg dose of hydroxyprogesterone caproate (brand name Makena) administered by injection. This drug is recognized nationally for its role in progesterone supplementation and associated care pathways. Accurate coding with J1726 is important for claims processing, clinical documentation, and national utilization tracking of injectable progestogen therapy.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, typical billing and service settings for J1726, and context on clinical use. The publication also summarizes benchmarks for utilization and reimbursement where available, highlights recent policy updates affecting injectable drug billing, and provides clinical context to help billing and compliance teams align coding with documented services.
Data not available in the input for certain details, such as associated taxonomies, specific ICD-10 pairings, and related codes.
Billing Code Overview
HCPCS Level II code J1726 represents an injection of hydroxyprogesterone caproate (Makena), 10 mg. This injectable medication is used for progesterone supplementation in clinical scenarios consistent with its labeling.
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Service type: Medication administration via injection
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Typical site of service: Outpatient clinic, physician office, or ambulatory care setting
Clinical & Coding Specifications
Clinical Context
A typical patient is a pregnant person with a history of a prior spontaneous singleton preterm birth seeking prevention of recurrent preterm delivery. The patient presents to an outpatient obstetrics clinic or a maternal-fetal medicine practice for evaluation at approximately 16 to 20 weeks gestation. After confirmation of eligibility (singleton pregnancy, prior spontaneous preterm birth between 20 0/7 and 36 6/7 weeks, no contraindications such as active liver disease or thromboembolic disorder), the clinician counsels on weekly intramuscular therapy with J1726 (hydroxyprogesterone caproate, Makena) 10 mg per unit vial.
The clinical workflow includes: initial intake and confirmation of gestational age; review of prior obstetric history and contraindications; baseline vital signs and brief physical exam; informed consent and documentation; preparation and verification of product lot and expiration; administration of the intramuscular injection (typically gluteal) in the clinic or outpatient ambulatory infusion setting; post-injection observation for allergic reaction or immediate adverse effects; scheduling of weekly follow-up injections through 36 weeks gestation or until delivery. Typical sites of service are outpatient obstetrics clinic, maternal-fetal medicine clinic, or ambulatory infusion center.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Default/standard service | Use when no modifier is required and the service is provided as usual. |