Summary & Overview
HCPCS J7294: Yearly Vaginal Contraceptive System (Segesterone/Ethinyl Estradiol)
HCPCS Level II code J7294 designates the yearly vaginal delivery system containing segesterone acetate and ethinyl estradiol (0.15 mg and 0.013 mg per 24 hours). This code is used for billing a long-acting, user-controlled contraceptive device that provides combined hormonal therapy via vaginal administration and is relevant to outpatient clinics, pharmacy dispensings, and family planning services. Nationally, coding clarity for long-acting contraceptive systems affects coverage determinations, pharmacy and clinic reimbursement, and patient access to contraceptive options.
Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for how this HCPCS Level II code is categorized for service lines and sites of service, an overview of clinical context for a yearly vaginal contraceptive system, and a summary of common billing modifiers and operational considerations. The report highlights where data is available and notes fields where input did not supply information. Intended for billing managers, health policy analysts, and clinic administrators, this summary clarifies the code’s clinical meaning and billing context for national reimbursement and operational workflows.
Billing Code Overview
HCPCS Level II code J7294 represents segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each. This code describes a combined progestin-and-estrogen contraceptive delivered via a vaginal system intended for yearly replacement.
Service Type: Hormonal contraceptive, vaginal delivery system
Typical Site of Service: Outpatient ambulatory settings, outpatient pharmacy dispensing, and clinics where long-acting contraceptive devices are provided
Clinical & Coding Specifications
Clinical Context
A 28-year-old female seeks long-term reversible contraception and is evaluated in an outpatient gynecology clinic. She has no contraindications to combined hormonal contraception, desires a user-controlled method that provides continuous systemic hormone delivery with yearly replacement, and opts for the segesterone acetate and ethinyl estradiol vaginal system described by J7294. The clinical workflow includes: an initial contraceptive counseling visit with documented informed consent and review of medical history (blood pressure, smoking status, migraine history, thromboembolic risk); a brief pelvic exam as indicated by history and age-appropriate screening; insertion instruction and demonstration of self-placement and removal; billing of the device using J7294 at the time of dispensation; scheduling a follow-up or annual visit for device exchange and monitoring. Typical site of service is an outpatient clinic, family planning clinic, or ambulatory care center where the device is dispensed and patient education is provided.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (default) | Use when no modifier applies and billing as furnished. |