February 20, 2015

State of Alabama
Press Release: Medicaid

Changes to the Plan First Program (Revised)

PDF Version

TO: All Family Planning Providers (physicians, FQHC, IRHC, PBRHC), Hospitals, Obstetricians-Gynecologists, and Plan First Providers

RE: Changes to the Plan First Program (Revised)

NOTE: THIS ALERT CLARIFIES THE ALERT DATED JANUARY 30, 2015

As a result of the renewal of the Alabama Plan First Section 1115 Family Planning Demonstration Waiver, the Alabama Medicaid Agency will cover the removal of embedded intrauterine devices in an office or outpatient hospital setting for Medicaid-eligible Plan First recipients, effective for dates of service February 1, 2015, and thereafter.

Note: Only Plan First-enrolled providers are able to provide services to Plan First recipients. Therefore, in order to receive reimbursement for the provision of this service to a Plan First recipient, a provider must be a Medicaid-enrolled Plan First provider.

The following CPT codes are applicable:

Procedure codes:

   * 57410-FP    Pelvic examination under anesthesia (other than local)

   * 00940-FP    Anesthesia for vaginal procedures (including biopsy of labia, vagina, cervix    
                       or endometrium); not otherwise specified

   * 57800-FP    Dilation of cervical canal, instrumental (separate procedure)

   * 58562-FP    Hysteroscopy, surgical; with removal of impacted foreign body

   * 00952-FP    Anesthesia for hysteroscopy and/or hysterosalpingography procedures

The following diagnosis codes must be billed on the claim form (UB-04 or CMS-1500) in order to be reimbursed by Medicaid:

ICD-9 diagnosis codes:

   * V2512       Encounter for removal of intrauterine contraceptive device

   * V2513       Encounter for removal and reinsertion of intrauterine contraceptive device

   * V2542       Intrauterine contraceptive device – Checking, reinsertion, or removal of intrauterine device

Place of Service:

   * 22       Outpatient hospital setting 

   * 11       Office visit

For questions regarding outpatient billing contact Solomon Williams, Associate Director, Institutional Services at 334-353-3206 or via e-mail at solomon.williams@medicaid.alabama.gov. For questions regarding office billing contact Sylisa Lee-Jackson, Associate Director, Maternity, Plan First/Family Planning and Nurse Midwife Program at 334-353-4599 or via e-mail at sylisa.lee-jackson@medicaid.alabama.gov.

 



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