J2675 Progesterone Injection HCPCS Reimbursement

Headline: HCPCS Level II code J2675 covers progesterone injections used across outpatient settings

Lead: HCPCS Level II code J2675 denotes the drug product billing for progesterone administered in 50 mg units. This code is relevant to clinicians and billing professionals who manage pharmacologic therapies provided in outpatient office settings, and it affects reimbursement, coding compliance, and inventory management nationally.

What the code represents and why it matters: J2675 is a drug-level HCPCS code used to report progesterone in 50 mg increments. As a discrete drug code, it is used on claims when progesterone is supplied for clinical indications such as menstrual disorders, ovarian dysfunction, endometriosis-related therapies, and contraceptive surveillance. Accurate use of this HCPCS code is important for consistent drug pricing, inventory tracking, and payer adjudication across the United States.

Key payers covered: The analysis addresses national payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.

What readers will learn: The publication summarizes how J2675 is used in clinical and billing workflows, explains typical sites of service and service type, reviews related procedural and drug codes for context, and highlights common claim-level considerations. Where input fields are incomplete, the document indicates missing metadata and points to areas requiring supplemental documentation.

Scope: Content is written for a national audience of clinicians, coding professionals, and revenue cycle staff. Data not available in the input is noted where applicable.

Billing Code Overview

HCPCS Level II code J2675 represents an injection of progesterone, per 50 mg. This code applies to pharmacologic administration of progesterone as a drug product rather than the administration procedure itself. The service type is Pharmacology and the typical site of service is Office (POS 11).

Data not available in the input.

Clinical Context

A 32-year-old woman presents to an outpatient obstetrics and gynecology office (POS 11) for administration of injectable progesterone for management of abnormal uterine bleeding and ovulatory dysfunction. The patient has a documented history consistent with heavy menstrual bleeding and anovulatory cycles; evaluation has already been completed and a decision was made to provide intramuscular or subcutaneous progesterone therapy. At the visit the clinician verifies indication, reviews allergies, obtains consent, prepares the calculated dose in 50 mg increments, administers the injection, documents lot number and amount administered, and counsels the patient on expected effects and follow-up. Billing uses HCPCS Level II code J2675 (Injection, progesterone, per 50 mg) for the drug component and a separate administration code such as 96372 if applicable. If any portion of the dispensed drug is discarded, modifier JW may be appended per payer policy. The typical workflow includes medication procurement, dose preparation, patient identification and counseling, injection administration, post‑administration observation, and documentation of drug lot, dose, route, and site.

Coding Specifications

Modifier JW - Drug amount discarded/not administered to any patient
- Use when a portion of a single‑use vial or prefilled syringe containing progesterone is prepared and some amount is discarded after administration to the patient. Append to HCPCS Level II code J2675 per payer requirements to report discarded drug quantity.
Modifier 59 - Distinct Procedural Service

National mean rates for HCPCS Level II code J2675 place the BUCA (average commercial) mean of $1.56 above Medicare's mean (Medicare not provided in the input; shown as $0.00 in the table for completeness), indicating higher average commercial reimbursement versus Medicare for this code. Blue Cross Blue Shield has the highest reported national mean at $2.18, while Aetna and UnitedHealthcare cluster near $1.11–$1.12.

Rate dispersion measured as the difference between the 75th and 25th percentiles is tightest for Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and BUCA, where P75 minus P25 equals $0.00 or nearly zero (all report P25 = $1.00 and P75 = $1.00). Aetna shows wider dispersion (P75 $0.50 vs P25 $0.20, range $0.30). The table and chart below present the full breakdown of mean rates and percentile dispersion by payer.

Related Diagnoses

N92.0 — Excessive and frequent menstruation with regular cycle
- Clinical relevance: Heavy menstrual bleeding can be managed medically with progesterone therapy to regulate bleeding and reduce endometrial proliferation; J2675 may be used when injectable progesterone is administered for this indication.
N91.2 — Amenorrhea, unspecified
- Clinical relevance: Amenorrhea may be an indication for hormonal evaluation and therapeutic progesterone in certain management pathways where injectable progesterone is used; J2675 would report the drug when given.
N80.0 — Endometriosis of uterus
- Clinical relevance: Progesterone therapies can be used to suppress endometrial activity and manage pain or bleeding associated with endometriosis; J2675 applies when injectable progesterone is administered as part of treatment.
Z30.42 — Encounter for surveillance of injectable contraceptive
- Clinical relevance: Follow‑up visits for surveillance after an injectable contraceptive may involve documentation and possible repeat administration; J2675 reports the progesterone product per 50 mg when the injectable contraceptive is a progesterone formulation.
E28.39 — Other primary ovarian failure
- Clinical relevance: Hormone replacement strategies, including progesterone supplementation, may be part of management; J2675 is used when injectable progesterone is administered.

Related Codes

96372 - Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
- Commonly billed when a clinician performs the act of injecting progesterone in the office. It describes the administration portion of the visit and is often reported with HCPCS Level II code J2675 for the drug supplied.
99213 - Established patient office or other outpatient visit, typically 15 minutes
- Represents the evaluation and management service for the office encounter when an established patient presents for progesterone injection and routine assessment. 99213 may be billed separately if the E/M documentation meets the payer’s requirements for a distinct visit.
J1050 - Injection, medroxyprogesterone acetate, 1 mg
- A different HCPCS Level II drug code for a progesterone formulation (medroxyprogesterone acetate). It may be an alternative drug code when that specific agent is used instead of the product reported with J2675.
J3490 - Unclassified drugs
- Used when a specific HCPCS Level II code is not available for the administered drug. Not typically used when J2675 is available for progesterone.

Note: HCPCS Level II code J2675 is the primary drug code for progesterone dosing per 50 mg and is commonly used in combination with an administration code like 96372 and an E/M code like 99213 when supported by documentation.

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Summary & Overview

HCPCS Level II J2675: Progesterone Injection, per 50 mg

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

Related Codes

Related Diagnoses

Related Codes

National Reimbursement Benchmarks

Related Codes