HCPCS code J7294: Yearly vaginal system, contraceptive system2026 Medicare rate & RVUs in Massachusetts

CMS doesn’t publish an office rate for J7294 in Massachusetts.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What J7294 covers

J7294 identifies a yearly vaginal system containing segesterone acetate and ethinyl estradiol. The listed release amounts are 0.15 mg and 0.013 mg per 24 hours, respectively. It is a hormonal contraceptive product used vaginally; report the product when the complete yearly system is furnished. This is distinct from the monthly-use etonogestrel and ethinyl estradiol vaginal ring identified by J7295.

Medicare assigns physician fee schedule status N, which indicates not covered, and the HCPCS coverage designation is not covered by statute. The HCPCS pricing designation says it is not separately priced by Medicare Part B. The code's unit is each complete yearly system; the release amounts describe the system's rate, not separate daily billing units. This code identifies the product rather than a daily supply.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where J7294 pays more and less in Massachusetts

How the J7294 rate is calculated

Each of J7294’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for J7294

J7294 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

J7294 compared with similar codes

How to choose

J7295Vaginal ringMonthly, each

J7295 identifies an etonogestrel and ethinyl estradiol vaginal ring intended for monthly use. J7294 identifies a different hormone combination in a system used over a year.

J7296Kyleena19.5 mg system

J7296 is a levonorgestrel-releasing intrauterine system. Choose J7294 for the segesterone acetate and ethinyl estradiol vaginal system.

J7297Liletta IUD52 mg system

J7297 identifies a levonorgestrel intrauterine system, not a vaginal ring. The codes represent different products and routes of administration.

Codes related to J7294

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates