Summary & Overview
HCPCS Level II J7296: Levonorgestrel IUD (Kyleena) 19.5 mg
HCPCS Level II code J7296 denotes the levonorgestrel-releasing intrauterine contraceptive system, marketed as Kyleena (19.5 mg). This device-level code is essential for billing the contraceptive product itself and is widely used in outpatient reproductive health settings. Nationally, clear coding for long-acting reversible contraception supports access, program reporting, and predictable claims processing for clinicians and facilities.
Key payers examined in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of coverage patterns and payer inclusion, common billing considerations tied to device coding, and the clinical context for use of the Kyleena IUD. The report summarizes benchmarks relevant to device-level reimbursement, notes common modifier usage where provided, and highlights potential policy updates that affect device coverage and prior authorization requirements.
Intended for billing professionals, revenue cycle leaders, and clinicians, the summary clarifies what J7296 represents, where it is typically billed, and what standard materials readers can expect: payer coverage landscape, clinical indications for use, and operational implications for outpatient contraceptive services. Data not available in the input for specific coverage policies, prior authorization criteria, or payer-specific rates is indicated where applicable.
Billing Code Overview
HCPCS Level II code J7296 represents a levonorgestrel-releasing intrauterine contraceptive system (Kyleena), 19.5 mg. The code is used to identify the device itself for billing purposes.
Service Type: Intrauterine contraceptive device placement (IUD)
Typical Site of Service: Outpatient clinic or ambulatory surgical center, including family planning, gynecology, or primary care outpatient settings where long-acting reversible contraception is provided.
Clinical & Coding Specifications
Clinical Context
A 28-year-old female presents to an outpatient gynecology clinic requesting long-acting reversible contraception. She desires an intrauterine device that provides local progestin release with decreased systemic hormonal exposure. After counseling on options, risks, benefits, and confirmation of no contraindications to intrauterine contraception, the clinician schedules same-day placement of a levonorgestrel-releasing intrauterine system, J7296 (Kyleena, 19.5 mg). The typical clinical workflow includes a pre-procedure history and focused pelvic exam, pregnancy test if indicated, informed consent, aseptic preparation, visualization with a speculum, cervical cleansing, optional local anesthesia or paracervical block, uterine sounding to determine depth, and insertion of the J7296 device according to manufacturer technique. Post-insertion, the patient is observed briefly for vasovagal symptoms, counseled on string checks and potential side effects (irregular bleeding, cramping), and provided documentation of the device lot number and insertion date. Follow-up is arranged 4–12 weeks post-placement or sooner if problems occur. Typical sites of service are outpatient clinic or ambulatory surgical center; placement is commonly performed by obstetrics and gynecology clinicians, family planning specialists, or advanced practice clinicians trained in IUD insertion.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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