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HCPCS J7296 · Level II · J code

J7296: Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for J7296

Medicare payment
no PFS amount
PFS status N
Coverage code
S
non-covered by Medicare statute
Practitioner MUE
0
MAI 3
OPPS status
SI E1
Non-allowed item or service
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

J7296 is a Level II code from the J section (drugs administered other than oral method and chemotherapy drugs), in use since 2018: "Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg". The physician fee schedule lists J7296 with status N (not covered by Medicare), so the PFS carries no national amount for it. Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy). No current LCD or billing article lists J7296; its HCPCS coverage code is S (non-covered by Medicare statute). OPPS status indicator E1: Non-allowed item or service. HCPCS record: BETOS P6C (minor procedures - other (Medicare fee schedule)); pricing indicator 00; type of service 9 (other medical items or services). 3 other active codes open with "Levonorgestrel-releasing intrauterine contraceptive system"; related codes: J7297, J7298, J7301, J7799.

J7296 descriptor and code status

The October 2026 HCPCS Level II file describes J7296 as “Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit.

HCPCS file attributes of J7296
FieldValue
Short descriptorKyleena, 19.5 mg
Added to HCPCS2018-01-01
Last actionN (no maintenance), effective 2018-01-01
Coverage codeS: non-covered by Medicare statute
Pricing indicator00: not separately priced by Part B
BETOS categoryP6C: minor procedures - other (Medicare fee schedule)
Type of service9: other medical items or services
Cross-referenceQ9984
Statute1862(a)(1)

Medicare payment for J7296

The physician fee schedule lists J7296 with status N (not covered by Medicare), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status N: not covered by Medicare. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator E1 (Non-allowed item or service), with no separate OPPS payment rate.

Medically Unlikely Edits for J7296

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for J7296 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalCMS Policy
Facility outpatient hospital03 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for J7296 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists J7296 in v323r0.

J7296 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J7296 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J7296

No current LCD or billing and coding article lists J7296. The HCPCS coverage code S means non-covered by Medicare statute, and any National Coverage Determination for the service still applies.

Denials to expect on J7296

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of J7296 exceed the practitioner MUE of 0 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for J7296 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J7296 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J7296

What does HCPCS code J7296 describe?

"Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg" (short descriptor "Kyleena, 19.5 mg"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 2018-01-01.

Is J7296 a CPT code?

No. J7296 is a CMS HCPCS Level II code; CPT codes are the AMA's five-character set.

What does Medicare pay for J7296?

The physician fee schedule lists J7296 with status N (not covered by Medicare), so the PFS carries no national amount for it.

How many units of J7296 can be billed per day?

Its 2026 Q4 MUEs per date of service: practitioner 0 (MAI 3, CMS Policy); hospital outpatient 0 (MAI 3, CMS Policy). For the practitioner MUE (MAI 3), units above 0 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover J7296?

No current LCD or billing article lists J7296; its HCPCS coverage code is S (non-covered by Medicare statute).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.