July 23, 2015

State of Alabama
Press Release: Medicaid

Coverage of Vasectomies under the Plan First Program

PDF Version

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

Effective for dates of service August 1, 2015, and thereafter, the Alabama Medicaid Agency will begin coverage of vasectomies under the Plan First Program for Plan First male recipients aged 21 or older.

The following CPT codes are applicable:
• 55250       Vasectomy- unilateral or bilateral, including postoperative semen 
• 55450       Ligation of vas deferens, unilateral or bilateral (doctor’s office setting only)                 
• 00921       Anesthesia for vasectomy, unilateral or bilateral
• 89300       Semen analysis; presence and/or motility of sperm
• 99205-FP  Initial visit
• 99213-FP  Periodic visit

This procedure is only covered in an office or outpatient hospital setting, the place of service must be indicated on the CMS 1500 claim form in order to be reimbursed by Medicaid.
Place of Service Codes:
• 11  Office visit
• 22  Outpatient hospital setting

The following diagnosis codes must be billed in conjunction with the above CPT codes on the claim form (UB-04 or CMS-1500) in order to be reimbursed by Medicaid.
ICD-9 diagnosis codes should be used for claims submitted with dates of service on or prior to September 30, 2015.
ICD-9 Diagnosis Codes:

• V2502 Initiation of other contraceptive measures
• V252   Sterilization-Admission for interruption of vas deferens
• V258   Other specified contraceptive management-post vasectomy sperm count

ICD-10 diagnosis codes should be used for claims submitted with dates of service October 1, 2015, or after: 
ICD-10 Diagnosis Code:
• Z30018  Encounter for initial prescription of other contraceptives
• Z302      Encounter for sterilization
• Z308      Encounter for other contraceptive management

For questions regarding billing for vasectomies, contact Ruth Harris, Program Manager, Plan First Program at 334-353-3562 or via email at ruth.harris@medicaid.alabama.gov.

  • For more information, visit http://medicaid.alabama.gov
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