J7294 HCPCS code: Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each
J7294 is the HCPCS Level II code for segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each. Its Medicare coverage code is S (Non-covered by Medicare statute): Medicare is barred by law from covering it. The NCCI unit limit is 1 per day on outpatient hospital claims.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | S — Non-covered by Medicare statute |
| Pricing indicator | 00 — Not separately priced by Medicare |
| BETOS category | Z2 |
| Added | 2021-10-01 |
| Last action effective | 2021-10-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Prescribing Information |
| practitioner claims | 1 | Prescribing Information |
What changed for J7294
- 2021-10-01: J7294 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J7294?
J7294 is the HCPCS Level II code for segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each. Short descriptor: "Seg acet and eth estr yearly".
Does Medicare cover J7294?
Coverage code S — Non-covered by Medicare statute. Medicare is barred by law from covering it.
How many units of J7294 can be billed per day?
1 on outpatient hospital claims; 1 on practitioner claims (NCCI medically unlikely edits).
Related J72 codes
- J7200 — Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu
- J7201 — Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u.
- J7202 — Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u.
- J7203 — Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu
- J7204 — Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu
- J7205 — Injection, factor viii fc fusion protein (recombinant), per iu
- J7207 — Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u.
- J7208 — Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u.
- J7209 — Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u.
- J7210 — Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u.
- J7211 — Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u.
- J7212 — Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram
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Next steps
- Run a reimbursement report for a device billed under J7294
- Watch J7294 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J7294
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.