CPT/HCPCS Description
81025 Urine pregnancy test, by visual color comparison methods
G9001 Coordinated care fee, initial rate
G9005 Coordinated care fee, risk adjusted maintenance
J9261 Injection, nelarabine, 50 mg
S9213 Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately); per diem (do not use this code with any home infusion per diem code)
S9127 Social work visit, in the home, per diem
S9470 Nutritional counseling, dietitian visit
T1001 Nursing assessment/evaluation
T1023 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter
S4993 Contraceptive pills for birth control (monthly supply).
J1050 Injection, medrowyprogesterone acetate, 1 mg
J7300 Intrauterine copper contraceptive (Paragard T380A).
J7302 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg (Mirena IUD).
J7303 Hormone containing vaginal ring (NuvaRing).
J7304 Contraceptive supply, hormone containing patch, each (Ortho-Evra patch).
J7306 Levonorgestrel (contraceptive) implant system, including implants and supplies.
J7307 Etonogestrel (contraceptive) implant system, including implant and supplies (Implanon).
A4266 Diaphragm for contraceptive use.
58300 Insertion of IUD
58301 Removal of IUD
11976 Removal, implantable contraceptive capsules
11981 Insertion, non-biodegradable drug delivery implant
IMPLANON IMPLANT
Effective with dates of service August 9, 2006 forward, the following reimbursement policy applies to the insertion and removal of the Implanon (etonogestrel) implant:
Clinically trained providers obtain the contraceptive implant (one per recipient per 3 years) from a specialty pharmacy authorized by the manufacturer. The physician will not be reimbursed by Medicaid for implant itself. The implant will be reimbursed as a pharmacy benefit.
Provider claims for the insertion, removal, or removal with reinsertion of the implant are to be submitted using the appropriate Procedure (11981-11983) and diagnosis (V25.5, V25.43, or V45.52) codes. If nationally approved changes occur to diagnoses or Procedure codes that relate to this implant at a future date, providers are to use the most accurate coding available for the particular date of service. [Other procedural and diagnosis codes may also be appropriate on this date of service, and providers are to use the codes that most accurately describe the service(s) provided.]
Claims submitted for this contraceptive implant and its insertion in excess of the manufacturer’s recommended guidelines are subject to review and action by the Department.
Documentation in the physician’s recipient record is to include evidence of recipient education regarding this long-acting contraceptive.
