HCPCS J7300 is officially defined as "Intrauterine copper contraceptive (paragard)." HCPCS J7300 is referenced in 10 tracked payer policy changes from New Jersey Medicaid, Florida Blue, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J7300 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
New Jersey Medicaid has clarified reimbursement rules for physician and outpatient-administered drugs, including LARC devices. Providers must now bill their actual drug acquisition cost as the submitted charge, and use modifier 'U8' when billing 340B drugs or LARC devices.
Florida Blue updated reimbursement for about 60 physician-administered drug codes in its Physician-Administered Drug Program, administered by Prime Therapeutics Management Medical Pharmacy Solutions, effective October 1, 2026. That date has already passed as of November 4, 2026, so the new rates should already be in use for the affected Florida Blue HMO, PPO, State Employees PPO and Truli for Health claims, and the practice should confirm its drug fee schedule reflects them.
Effective October 1, 2026, Kansas Medical Assistance Program (KMAP) now covers Long-Acting Reversible Contraceptives (LARCs) when provided in mobile clinics and billed with Place of Service (POS) 15. Six FDA-approved LARC products are covered under the clinic benefit when specific operational and physician direction requirements are met. Billing teams must update systems to recognize POS 15 for LARC services and ensure mobile clinic eligibility requirements are documented.
Connecticut Medicaid (CMAP) has updated reimbursement rates for two long-acting reversible contraceptive devices effective January 1, 2026. The ParaGard copper IUD (J7300) will be reimbursed at $1,187.00 and the etonogestrel implant (J7307) at $1,275.36.
Pennsylvania Medical Assistance updated the Family Planning Services Program fee schedule for providers in the fee-for-service system, in a bulletin issued December 30, 2025. The update adds or end-dates procedure codes, says certain codes must be billed with the FP modifier or with ICD-10 diagnosis Z30.011 through Z30.9, sets new fees for J7296, J7297, J7298, J7300, J7301 and J7307 effective May 1, 2025, and changes units and limits for laboratory codes 87490 and 87492 for dates of service on and after December 1, 2025. Other dated changes include code 87521 added effective June 27, 2024, LARC device and insertion codes opened with the FP modifier effective April 1, 2025, code S4989 end-dated effective May 1, 2025, and code 87626 added effective December 1, 2025 along with the FP modifier for codes 87491, 87563 and 87591.
Independence Blue Cross updated preventive care policy 00.06.02aw to 00.06.02ba, effective 10/01/2025, making targeted HCPCS and ICD-10 code updates. Key changes include: adding HCPCS J0525 for colorectal cancer screening services (replacing S0074), adding HCPCS A4288 for breastfeeding supplies, clarifying J7300 intrauterine contraceptive description, and adding new ICD-10 codes for financial insecurity counseling and BRCA genetic testing. Billing teams must update systems to recognize the new/replaced codes and ensure proper claim adjudication at $0 cost-share for qualifying preventive services.
Nevada hospitals (inpatient and critical access) can now bill LARC (long-acting reversible contraception) services separately from per diem rates under Fee-for-Service Medicaid. These services must be billed as outpatient claims and can occur concurrently with inpatient stays.
Health First Colorado (Colorado's Medicaid Program) required prior authorization for a list of genetic testing codes effective February 10, 2020, and the Department said it intends to require prior authorization for all codes from 81170 through 81599 in phases. The bulletin also changed the Brain Injury Waiver Independent Living Skills Training benefit to a 15 minute unit effective February 1, 2020, and set billing rules for immediate post-partum LARC devices in DRG hospitals effective January 1, 2020.
AHCCCS designated the CR modifier for all claims for services provided as a result of, or related to, COVID-19, and providers are asked to begin using it immediately in all appropriate instances. Hospitals may bill long acting reversible contraceptive (LARC) devices separately from the APR-DRG payment on a CMS 1500 claim with the appropriate HCPCS code, reimbursed at the AHCCCS fee schedule rate. Telehealth at the All Inclusive Rate is billed on a UB-04 with revenue codes 0510, 0512 and 0516 and a GT or GQ modifier to indicate telehealth.
Qualified emergency medical service providers, defined as ADHS licensed or certified AHCCCS registered provider types 06, 97 and TR, may bill AHCCCS for the flu vaccine and its administration effective October 1, 2020, on a separate claim form and not as part of a transport. Long acting reversible contraceptive (LARC) devices HCPCS J7297, J7298, J7300 and J7301, along with procedure code 58300, are reimbursed separately from the APR-DRG payment when billed by a hospital on a CMS 1500 claim. Claims that fail to meet AHCCCS requirements are returned to the provider as un-processable, and common causes include data entered in the wrong field, stamps on the claim and copies of the form.
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