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.
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
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
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 firstname.lastname@example.org or call the Provider Assistance Center at 800-688-7989.