2025 HCPCS code J7296
(Active) Effective Date: N/A Drugs Administered Other than Oral Method - Contraceptive Systems Feed
Levonorgestrel-releasing intrauterine contraceptive system (Kyleena®), 19.5 mg.
Modifiers may be applicable depending on the payer and specific circumstances (e.g., JW for discarded drug amount).
Medical necessity is supported by the patient's need for contraception. Additional justification may be required for patients with certain medical conditions.
This code is reported for the supply of the Kyleena® IUS, not the insertion procedure. The provider is responsible for ensuring proper insertion and patient counseling regarding potential risks and benefits.
In simple words: Kyleena is a small, T-shaped plastic device placed inside the uterus to prevent pregnancy for up to 5 years. It slowly releases a hormone called levonorgestrel.
Kyleena® is a levonorgestrel-releasing intrauterine contraceptive system (IUS) that contains 19.5 mg of levonorgestrel, a progestin hormone. It is inserted into the uterus for contraception, providing protection for up to 5 years. The standard release rate of levonorgestrel starts at 17.5 mcg/day and gradually reduces to 7.4 mcg/day over the 5-year period.
Example 1: A 25-year-old woman requests a long-acting reversible contraceptive method and chooses Kyleena. The provider inserts the device during an office visit., A 38-year-old woman with heavy menstrual bleeding desires contraception and symptom relief. Kyleena is chosen for its potential to reduce bleeding., A patient has Kyleena inserted during a postpartum visit.
Documentation should include details about the patient's medical history, consent for the procedure, confirmation of the device insertion, lot number of the device used, and counseling provided to the patient.
** Check with individual payers regarding coverage and coding guidelines. Some payers might require specific documentation or pre-authorization for reimbursement.
- Payment Status: Active
- Specialties:Obstetrics and Gynecology, Family Medicine
- Place of Service:Office, Inpatient Hospital, On Campus-Outpatient Hospital,Off Campus-Outpatient Hospital