Summary & Overview
HCPCS Level II J7298: Levonorgestrel IUD (Mirena), 52 mg
HCPCS Level II code J7298 identifies the levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg. As a durable, long-acting reversible contraceptive device, this code is central to reproductive health service lines and outpatient women's health corridors nationwide. Proper coding of J7298 affects device coverage, patient cost-sharing, and facility billing for insertion services.
Key payers referenced include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of clinical context for the device, typical sites of service, and the payer landscape most relevant to coverage and claims handling. The publication summarizes common billing modifiers used with device codes, outlines typical service line placement, and provides benchmarking insights where available.
This summary equips billing managers, revenue cycle staff, and policy analysts with a concise reference to the clinical purpose of J7298, payer considerations, and the types of documentation and service settings associated with Mirena device charges. Data not available in the input will be explicitly noted in detailed sections.
Billing Code Overview
HCPCS Level II code J7298 represents the levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg. This code covers the device itself used for long-acting reversible contraception.
Service type: Contraceptive device (intrauterine system)
Typical site of service: Outpatient clinic, office, or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 32-year-old female presents to an outpatient gynecology clinic requesting long-acting reversible contraception. She has completed counseling and desires a levonorgestrel-releasing intrauterine system (Mirena, 52 mg). The clinical workflow includes informed consent, pregnancy testing as indicated, a pelvic exam, cervical cleansing, possible local anesthesia, insertion of the J7298 device into the uterine cavity, immediate post-procedure counseling, and a follow-up visit in 4–6 weeks to confirm placement and address side effects. Typical sites of service are outpatient physician offices, ambulatory surgery centers, and family planning clinics. The procedure is performed by an obstetrician-gynecologist, family medicine physician with procedural training, or certified nurse practitioner/physician assistant in contraception services. Billing will include the device supply code J7298 and applicable procedural CPT codes and modifiers for the insertion encounter.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when an E/M visit is provided on the same day as IUD insertion and is separate from the procedure-related care |