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See a sample rate comparisonHCPCS J7294 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Contraceptive Systems |
| Common Place of Service | 11 - Office 71 - Public Health Clinic |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for J7294 |
National average reimbursement for HCPCS J7294 by major payers:
$2,275.25
$2,544.14
$2,471.29
$2,484.88
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HCPCS J7294
5 of 25 sample ratesHigher to lower in this preview
University Of California Irvine, Uci Medical Center
Regents Of The University Of California At Irvine
$10,116.63Published rateBrigham And Women'S Hospital
Advocate Health And Hospitals Corporation
$3,333.17Published rateSt. Luke'S Methodist Hospital, Inc.
Unity Healthcare
$2,493.15Published rateSteward St. Elizabeth'S Medical Center Of Boston, Inc.
$2,493.15Published rateBeavercreek Medical Center, Soin Medical Center
Beavercreek Medical Center
$1,543.39Published rate
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See a sample payer proposalHCPCS J7294 vs. Other Contraceptive Systems Codes
The HCPCS J7294 code is part of the Drugs Administered Other than Oral Method services used for Contraceptive Systems. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS J7294 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| J7213-HCPCS | Low | Injection, coagulation factor ix (recombinant), ixinity, 1 i.u. |
| J7294-HCPCS | High | Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each |
| J7295-HCPCS | Low | Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7294. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7294 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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