News

Coding Changes for Injection, Medroxyprogesterone Acetate

2/10/2013

TO:  Physicians, Physician Assistants, Nurse Practitioners,
Oral Surgeons, FQHCs, IRHCs, Health Departments, Hospitals,
and Provider Associations


Effective December 31, 2012, CPT® procedure codes J1051 and J1055 for billing medroxyprogesterone acetate injections were deleted.  Effective for dates of service January 1, 2013, CPT® procedure code J1050, Injection, medroxyprogesterone acetate, 1 mg, must be used with a required modifier for all claims.  J1050 replaces the following codes:

J1051 – Injection, medroxyprogesterone acetate, 50 mg*

J1055 - Injection, medroxyprogesterone acetate for contraceptive use, 150 mg*  
            
*NOTE:  J1051 and J1055 will continue to be used for dates of service prior to January 1, 2013.

 

Billing Instructions:

Procedure code J1050 will require the use of a modifier in order for Medicaid to identify when the injection is for contraceptive use versus non-contraceptive use.

1.    For contraceptive use:

J1050 with modifier FP and include a contraceptive management diagnosis code 

 

2.    For non-contraceptive use :

J1050 with modifier U1

 

Restrictions:

J1050-FP will be limited to female recipients 10 to 55 years of age

J1050-FP is limited to no less than 104 mg and no more than 150 mg per injection

J1050-FP injection will be allowed once every 70 days

J1050-FP must use a contraceptive management diagnosis code

 

J1050-U1 is covered for recipients of all ages

J1050-U1 is limited to 1000 mg per injection

J1050-U1 does not have a limitation other than the maximum units allowed per injection

J1050-U1 cannot use a contraceptive management diagnosis code

 

Reimbursement Amount:

The reimbursement rate for J1050 is $0.20 per unit (1mg).

 

Since the code description is based on 1mg, providers should bill the applicable units based on the 1mg.  Examples:

·         A medroxyprogesterone acetate  injection was given for 150 mg for contraceptive use.  The provider would bill J1050-FP for 150 units and use a contraceptive management diagnosis code.

·         A medroxyprogesterone acetate  injection was given for 500 mg for non-contraceptive use.  The provider would bill J1050-U1 for 500 units.

 

Claims for J1050 billed without a modifier will be denied for the modifier requirement.

 

For questions, contact Sylisa Lee-Jackson at (334) 353-4599 or sylisa.lee-jackson@medicaid.alabama.gov  or call the Provider Assistance Center at 800-688-7989.