TO: All
Hospitals and All Physicians
Effective for dates of service June 3, 2019, and thereafter,
the Alabama Medicaid Agency (Medicaid) will reimburse the cost of long-acting
reversible contraceptives to the facility when provided in the inpatient
hospital setting immediately after a delivery or up to the time of the
inpatient discharge for postpartum women, or in the outpatient setting
immediately after discharge from the inpatient hospital for postpartum women.
What steps are necessary for the hospital to receive
reimbursement for LARC services when provided in the inpatient setting?
1. The
hospital must submit a UB04 claim (bill type 111) to Medicaid for inpatient
delivery services with an International Classification of Diseases, Tenth
Edition (ICD–10) delivery diagnosis code within the range O00.0 – O9A.53 and
one of the following ICD–10 surgical codes for insertion of the device:
• 0UH97HZ
• 0UH98HZ
• 0UHC8HZ
Note for the delivery claim: Submit prior to the LARC claim and do not include a LARC code.
2. The
hospital must submit a separate UB-04 claim (bill type 131) to Medicaid with
one of the following Healthcare Common Procedure Coding System (HCPCS) codes
with the appropriate National Drug Code (NDC) to receive reimbursement for the
LARC:
• J7296 —
Kyleena®
• J7297 —
Liletta®
• J7298 —
Mirena®
• J7300 —
Paragard®
• J7301 —
Skyla®
• J7307 —
Nexplanon®
Note for the LARC claim:
Do not submit prior to the delivery claim and do not include an
insertion code. In addition, the date of
service for this claim should be for the actual date of insertion and must
overlap the submitted dates of services for delivery.
What steps are necessary for the hospital to receive
reimbursement for LARC services when provided in the outpatient setting?
1. The hospital
must submit a UB04 claim (bill type 131) to Medicaid.
2. The
hospital must use one of the following insertion Common Procedural Terminology
(CPT) codes:
• 58300 —
Insertion of IUD
• 11981 —
Insertion, non-biodegradable drug delivery implant (must add ‘FP’ modifier)
• 11983 —
Removal with reinsertion, non-biodegradable drug delivery implant (must add
‘FP’ modifier)
3. The
hospital must use one of the following ICD-10 codes:
• Z30.018 —
Encounter for initial prescription of other contraceptives
• Z30.430 —
Encounter for insertion of intrauterine contraceptive device
• Z30.49 —
Encounter for surveillance of other contraceptives
4. The
hospital must use one of the following HCPCS codes with the appropriate NDC to
receive reimbursement for LARC:
• J7296 —
Kyleena®
• J7297 —
Liletta®
• J7298 —
Mirena®
• J7300 —
Paragard®
• J7301 —
Skyla®
• J7307 —
Nexplanon®
What steps are
necessary for the physician to receive reimbursement for LARC services provided
in the inpatient or outpatient hospital setting?
1. The
physician must submit a CMS 1500 claim form to Medicaid.
2. The
physician must use one of the following insertion CPT codes:
• 58300 —
Insertion IUD
• 11981 —
Insertion, non-biodegradable drug delivery implant (must add ‘FP’ modifier)
• 11983 —
Removal with reinsertion, non-biodegradable drug delivery implant (must add
‘FP’ modifier)
3. The
physician must use one of the following ICD-10 codes:
• Z30.018 —
Encounter for initial prescription of other contraceptives
• Z30.430 —
Encounter for insertion of intrauterine contraceptive device
• Z30.49 —
Encounter for surveillance of other contraceptives
4. The
physician must indicate the place of service as one of the following:
• 21 —
Inpatient hospital setting
• 22 —
Outpatient hospital setting
For questions regarding hospital program, contact Solomon
Williams at
solomon.williams@medicaid.alabama.gov.
For questions regarding physician program, contact Elizabeth
Huckabee at elizabeth.huckabee@medicaid.alabama.gov.
For questions regarding the family planning program, contact
Pamela Moore at pamela.moore@medicaid.alabama.gov.
For questions regarding billing, contact the DXC Provider
Assistance Center at (800) 688-7989.