HCPCS J7294 Fee Schedule
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.
| 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 |
National average reimbursement for HCPCS J7294 by major payers:
$2,275.25
$2,544.14
$2,471.29
$2,484.88
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS J7294 | ||||||
United | J7294 | $2493.15 | 1780770701 - NEWBERRY COUNTY MEMORIAL HOSPITAL | 570324929 - (SC) NEWBERRY COUNTY MEMORIAL HOSPITAL | SC | General Acute Care Hospital (282N00000X) |
United | J7294 | $1543.39 | 1760764849 - BEAVERCREEK MEDICAL CENTER, SOIN MEDICAL CENTER | 270712680 - (OH) BEAVERCREEK MEDICAL CENTER | OH | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1164630893 - ST. LUKE'S METHODIST HOSPITAL, INC. | 420680337 - UNITY HEALTHCARE | IA | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1760498588 - PIEDMONT NEWTON HOSPITAL, INC., NEWTON MEDICAL CENTER | 582155150 - (GA) PIEDMONT NEWTON HOSPITAL INC | GA | General Acute Care Hospital (282N00000X) |
United | J7294 | $2642.75 | 1952418352 - GENEVA GENERAL HOSPITAL INC. | 160743032 - (NY) GENEVA GENERAL HOSPITAL | NY | General Acute Care Hospital (282N00000X) |
United | J7294 | $5287.35 | 1043318967 - UNIVERSITY OF CALIFORNIA, SAN FRANCISCO, UCSF MEDICAL CENTER | 943281660 | CA | General Acute Care Hospital (282N00000X) |
United | J7294 | $4564.45 | 1467496802 - ST FRANCIS HOSPITAL, INC., ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1427132604 - GENESIS HEALTH SYSTEM, GENESIS MEDICAL CENTER - SILVIS | 421418847 - GENESIS HEALTH SYSTEM | IL | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1609822881 - COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC, FROEDTERT MENOMONEE FALLS HOSPITAL | 843381796 | WI | General Acute Care Hospital (282N00000X) |
United | J7294 | $2892.90 | 1073711065 - MEDSTAR GEORGETOWN MEDICAL CENTER, INC, GEORGETOWN UNIVERSITY HOSPITAL PHYSICIANS | 522218584 - (DC) MEDSTAR-GEORGETOWN MEDICAL CENTER INC | DC | General Acute Care Hospital (282N00000X) |
United | J7294 | $4022.26 | 1578504056 - MERCY HOSPITAL SPRINGFIELD, MERCY HOSPITAL SPRINGFIELD | 440552485 - MERCY HOSPITAL SPRINGFIELD | MO | General Acute Care Hospital (282N00000X) |
United | J7294 | $10116.63 | 1689608150 - UNIVERSITY OF CALIFORNIA IRVINE, UCI MEDICAL CENTER | 952226406 - REGENTS OF THE UNIVERSITY OF CALIFORNIA AT IRVINE | CA | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1225032881 - GOOD SAMARITAN HOSPITAL | 356001532 - GOOD SAMARITAN HOSPITAL | IN | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1982980306 - RIAMD INC | 274507064 - (CA) RIAMD INC | CA | General Acute Care Hospital (282N00000X) |
United | J7294 | $4564.45 | 1255684460 - INOVA HEALTH CARE SERVICES, INOVA ALEXANDRIA HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | General Acute Care Hospital (282N00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS 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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