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 | 1356391775 - TOMAH VAMC | 391765537 - (WI) TOMAH VAMC | WI | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1407313760 - HH HEALTH SYSTEM, MARSHALL MEDICAL CENTER | 831651180 | AL | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1851336044 - ST. JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC., FROEDTERT WEST BEND HOSPITAL | 390806302 - (WI) ST JOSEPHS COMMUNITY HOSPITAL OF WEST BEND INC | WI | General Acute Care Hospital (282N00000X) |
United | J7294 | $2351.38 | 1144227935 - CONCORDIA PARISH HOSPITAL SERVICE DISTRICT NUMBER ONE, TRINITY MEDICAL | 720578642 - (LA) RIVERLAND MEDICAL CENTER | LA | Critical Access Hospital (282NC0060X) |
United | J7294 | $2493.15 | 1083866453 - PROVIDENCE HEALTH & SERVICES, PROVIDENCE HOLY FAMILY HOSPITAL | 352345508 | WA | General Acute Care Hospital (282N00000X) |
United | J7294 | $1954.64 | 1679911572 - EMAD HANNA | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | General Acute Care Hospital (282N00000X) |
United | J7294 | $2742.47 | 1457393035 - ST MARYS MEDICAL CENTER, ESSENTIA HEALTH ST MARYS MEDICAL CENTER | 460224743 - AVERA MCKENNAN | MN | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1033168786 - HOUSTON VAMC | 760418077 | TX | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1902236573 - CREEK NATION HOSPITAL & CLINICS, MUSCOGEE (CREEK) NATION MEDICAL CENTER | 731357965 - (OK) MUSCOGEE (CREEK) NATION DEPARTMENT OF HEALTH | OK | General Acute Care Hospital (282N00000X) |
United | J7294 | $2518.09 | 1619916806 - ST JOSEPH MEDICAL CENTER, OSF SAINT JOSEPH MEDICAL CENTER | 370662576 | IL | General Acute Care Hospital (282N00000X) |
United | J7294 | $2567.94 | 1538485768 - HENRY FORD MACOMB HOSPITALS | 382947657 - (MI) HENRY FORD MACOMB HOSPITAL CORPORATION | MI | General Acute Care Hospital (282N00000X) |
United | J7294 | $2493.15 | 1902236573 - CREEK NATION HOSPITAL & CLINICS, MUSCOGEE (CREEK) NATION MEDICAL CENTER | 731357965 - (OK) MUSCOGEE (CREEK) NATION DEPARTMENT OF HEALTH | OK | General Acute Care Hospital (282N00000X) |
United | J7294 | $2374.43 | 1295856755 - MAGEE BENEVOENT ASSOCIATION, MAGEE GENERAL HOSPITAL CRNA | 640324402 - (MS) MAGEE BENEVOLENT ASSOCIATION | MS | General Acute Care Hospital (282N00000X) |
United | J7294 | $4128.16 | 1871704833 - BRIGHAM & WOMEN'S HOSPITAL | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | General Acute Care Hospital (282N00000X) |
United | J7294 | $3163.82 | 1154342426 - STEPHANIE MOSS | 592579938 - UNIVERSITY OF MIAMI | FL | 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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