Effective for dates of service April 1, 2014, and thereafter, Alabama Medicaid will cover long acting birth control in the inpatient hospital setting immediately after a delivery or up to the time of the inpatient discharge for postpartum women, or in an outpatient setting immediately after discharge from the inpatient hospital. The cost of the device or drug implant will be captured in the hospital’s cost. The insertion of the device/drug implant will be billable to Medicaid by both the physician and hospital for reimbursement.
Inpatient Hospital Setting:
The hospital will continue to bill Medicaid for inpatient delivery services. The hospital must use an ICD-9 delivery diagnosis code within the range 630 – 67914 and must use the ICD-9 surgical code 69.7 (insertion contraceptive device) to document LARC services provided after the delivery.
NOTE: No additional payment will be made to the hospital for LARC inpatient services. The hospital must capture the cost of the device or drug implant in the hospital’s cost.
Outpatient Hospital Setting:
When a postpartum woman is discharged from the hospital, she may receive a LARC in the outpatient hospital setting immediately after discharge from the inpatient hospital. The hospital should bill on a UB-04 claim form using one code from each of the following: *Modifier “FP” is required on 11981 and 11983.
Procedure codes:
· 58300 — Insertion of IUD
· 11981-FP*— Insertion, non-biodegradable drug delivery implant
· 11983-FP*— Removal with reinsertion, non-biodegradable drug delivery implant
ICD-9 diagnosis codes:
· V255 Encounter for contraceptive management, insertion of implantable
subdermal contraceptive
· V2511 Insertion of intrauterine contraceptive device
· V2502 Initiate contraceptive NEC
· V251 Insertion of IUD
NOTE: The inpatient claim must be in Medicaid’s system in order for outpatient services to be paid. The inpatient and outpatient hospital must capture the cost of the device through the cost report.
Physician Billing for LARC Services Provided in the Inpatient/Outpatient Hospital Settings:
The physician should bill Medicaid utilizing a CMS 1500 claim form and one code from each of the following:
Procedure codes:
· 58300 — Insertion of IUD
· 11981-FP*— Insertion, non-biodegradable drug delivery implant
· 11983-FP*— Removal with reinsertion, non-biodegradable drug delivery implant
*Modifier “FP” is required on 11981 and 11983.
ICD-9 diagnosis codes:
· V255 Encounter for contraceptive management, insertion of implantable
subdermal contraceptive
· V2511 Insertion of intrauterine contraceptive device
· V2502 Initiate contraceptive NEC
· V251 Insertion of IUD
Place of Service:
· 21 — Inpatient hospital setting
· 22 — Outpatient hospital setting
There are no changes to contraceptive management services currently furnished in the physician’s office setting. These services will continue to be billed as you do today.
NOTE: The Alabama Medicaid Agency covers permanent sterilization only if the recipient has signed a consent form at least 30 days before the procedure is performed.
For questions regarding hospital billing contact Solomon Williams, Associate Director, Institutional Services at 334-353-3206 or via e-mail at solomon.williams@medicaid.alabama.gov.
For questions regarding physician billing contact Jessie Burris, Program Manager, Physicians Program, at 334-242-5014 or via e-mail at jessie.burris@medicaid.alabama.gov.