`J7296` Kyleena, 19.5 mg

Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg

Medicare coverage: Non-covered by statute
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 0 units per day (clinical), rationale: CMS Policy
Outpatient hospital: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J7296

Physician Fee Schedule (CY 2026, RVU26D)

Status N: non-covered service.

Payer policies and prior authorization for J7296

Payer coverage policies that name J7296

J7296 appears in 15 coverage policies from Aetna, Capital Blue Cross, Premera Blue Cross, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Progestins (0510)	covered if criteria are met	Jul 13, 2026	payer document
Capital Blue Cross	Noncontraceptive Use of Intrauterine Devices (IUDs) (MP 7.026) Procedure codes	unproven / investigational	Jun 1, 2026	payer document
Premera Blue Cross	Preventive Care Contraceptive implantable devices (insertion and removal)	covered if criteria are met	Sep 21, 2026	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (CS002.AG) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (2026T0442VV) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Idaho Only) (CS002ID.C) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Kansas Only) (CS002KS.02) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Kentucky Only) (CS002KY.10) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Nebraska Only) (CS002NE.AG) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for New Jersey Only) (CS002NJ.AE) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for New Mexico Only) (CS002NM.C) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for North Carolina Only) (CSNCT0442.06) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Ohio Only) (CS002OH.D) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Pennsylvania Only) (CS002PA.AE) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Tennessee Only) (CS002TN.AF) Levonorgestrel-Releasing Intrauterine Device	listed, no stance	Nov 1, 2025	payer document

Medicaid fee-for-service

AZ: $1272.44 (outpatient_hospital), effective Apr 1, 2026
FL: $1.00 (physician_administered_drugs), effective Jan 1, 2026
IL: $1272.44 (practitioner), effective Jan 1, 2026
IN: $1135.65 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2026
KS: $954.33 (default, Exempt Physician), effective Jan 1, 2026
KY: $1049.24 (preventive), effective Jan 1, 2026
LA: $1272.44 (dme), effective Jul 1, 2026
MS: $1272.44 (comprehensive), effective Jul 1, 2026
NE: $1358.97 (injectables), effective Jul 1, 2026
OH: $1361.51 (provider_administered_drugs), effective Jul 1, 2026
OK: $1214.63 (outpatient_hospital_apc), effective Jan 1, 2026
TX: $597.03 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), non-facility), effective Apr 1, 2026
VA: $1214.63 (medical), effective Jan 1, 2025
VT: $1214.63 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $1272.44 (family_planning, non-facility), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J7296 Kyleena, 19.5 mg