Get 17P Alpha-Hydroxyprogesterone Caproate Pharmacy Referral Form

Based on the active ingredient, compounded preservative-free 17P is considered clinically interchangeable with .

Please include the appropriate CPT code for any ® (hydroxyprogesterone caproate injection) related service in Box 24D of the CMS 1500 claim form. Submit a charge for the office visit using the injection code OR the appropriate office visit (Evaluation and Management) code (99201–99214), not both.

Based on the active ingredient, compounded preservative-free 17P is considered clinically interchangeable with .

® (hydroxyprogesterone caproate injection) has a unique J code J1726 as of January 1, 2018. The code should be used in column 24D of the CMS 1500 claim form. A National Drug Code (NDC) and quantity should be used when billing . Use one of the following codes in Box 19 of the CMS 1500 claim form.

2023 HCPCS Code J1726 : Injection, hydroxyprogesterone caproate, (), 10 mg.

Do not give yourself injections. A healthcare provider will give you the injection 1 time each week (every 7 days) either: in the back of your upper arm as an injection under the skin (subcutaneous), or. in the upper outer area of the buttocks as an injection into the muscle (intramuscular).

Providers may be reimbursed for the administration of the 17P compound injection by indicating procedure code 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) on the claim.

HCPCS code J1726 for Injection, hydroxyprogesterone caproate, (), 10 mg as maintained by CMS falls under Drugs, Administered by Injection .