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See a sample rate comparisonHCPCS J7296 (Kyleena) 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.
Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg
| Key Fact | Detail |
|---|---|
| Service Type | Drugs Administered Other than Oral Method Contraceptive Systems |
| Common Place of Service | 11 - Office None 50 - Federally Qualified Health Center |
| Complexity Level | High |
| Medicaid Fee Schedule | View Medicaid rates for J7296 |
| WAC Price | Lorem ipsum dolor sit amet consectetur Lorem ipsum dolor sit amet consectetur VisitBuyandBill.com |
National average reimbursement for HCPCS J7296 by major payers:
$1,082.70
$1,215.98
$1,296.40
$1,224.90
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HCPCS J7296
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
Merrimack Valley Pediatric Associates, Inc.
$2,621.28Published rateChristopher Raio
Good Samaritan Hosptial Medical Center
$1,202.84Published rateNancy Gaba
Medical Faculty Associates Inc
$1,191.48Published rateChristopher Raio
Mercy Medical Center
$1,134.75Published rateHailey Macnear
Sutter Valley Medical Foundation
$1,110.90Published rate
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See a sample payer proposalHCPCS J7296 vs. Other Contraceptive Systems Codes
The HCPCS J7296 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 J7296 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 |
|---|---|---|
| J7295-HCPCS | Low | Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each |
| J7296-HCPCS | High | Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg |
| J7297-HCPCS | Moderate | Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS J7296. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the J7296 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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