July 31, 2015

State of Alabama
Press Release: Medicaid

Coverage of Liletta IUD under the Plan First/Family Planning Program

PDF Version

NOTE: THIS ALERT REPLACES THE ALERT DATED JULY 14, 2015

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


Effective for dates of service April 1, 2015, and thereafter, the Alabama Medicaid Agency will begin coverage of the Liletta Intrauterine Device (IUD). Currently, Liletta is approved for only 3 years of continuous use. The following procedure will be used to bill for a Liletta IUD.

 

·         Effective for dates of service April 1, 2015 through July 31, 2015, providers will use an Unclassified Drug code to bill for a Liletta IUD. The following HCPCS Code is applicable: 

J3490       Unclassified Drug             

 

·         Effective for dates of service August 1, 2015, and thereafter, providers will use the following HCPCS Code to bill for a Liletta IUD:  

J7302       Liletta IUD


 

·         Effective for dates of service August 1, 2015, and thereafter, an “FP” modifier must be used to bill for a Mirena IUD.  The following HCPCS Code is applicable: 

J7302-FP  Mirena IUD

 

The following CPT codes are applicable:

 

 58300         Insertion of intrauterine device

o   58301         Removal of intrauterine device

 

This procedure is only covered in an office setting. The place of service must be indicated on the CMS 1500 claim form in order to be reimbursed by Medicaid. The following Place of Service Code is applicable:

 

o   11               Office visit

 

The following Diagnosis Codes must be billed in conjunction with the above HCPCS and CPT codes 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. The following ICD-9 Diagnosis Codes are applicable:


 

o   V2502        Initiation of other contraceptive measures

o   V2511        Encounter for insertion of intrauterine contraceptive  device

o   V2512        Encounter for removal of intrauterine contraceptive device

o   V2513        Encounter for removal and reinsertion of intrauterine contraceptive device

o   V2542        Checking of intrauterine contraceptive device

 

ICD-10 diagnosis codes should be used for claims submitted with dates of service October 1, 2015, or thereafter. The following ICD-10 Diagnosis Code are applicable:          

 

o   Z30014   Encounter for initial prescription of intrauterine

                    contraceptive device

o   Z30430   Encounter for insertion of intrauterine contraceptive

                    device

o   Z30431   Encounter for routine checking of intrauterine

                    contraceptive device

o   Z30432   Encounter for removal of intrauterine

                    contraceptive device

o   Z30433   Encounter for removal and reinsertion of intrauterine

                    contraceptive device

 

For questions regarding billing for the Liletta or Mirena IUDs, contact Ruth Harris, Program Manager, Plan First Program at 334-353-3562 or via e-mail at ruth.harris@medicaid.alabama.gov.

 

The billing policy for unclassified J codes can be found on the Alabama Medicaid Agency’s Website at http://www.medicaid.alabama.gov/documents/6.0_Providers/6.7_Manuals/6.7.1_Provider_Manuals_2015/
6.7.1.3_July_2015/Jul15_H.pdf
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  • For more information, visit http://medicaid.alabama.gov
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