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TO:  Family Planning Providers (Physicians, FQHC, IRHC, PBRHC) and All Hospitals

As a result of the renewal of the Alabama Plan First Section 1115 Family Planning Demonstration Waiver, the Alabama Medicaid Agency will cover the removal of embedded intrauterine devices in an office or outpatient hospital setting for Medicaid-eligible Plan First recipients, effective for dates of service February 1, 2015, and thereafter. The following CPT codes are applicable:

Procedure codes:
    *57410-FP    Pelvic examination under anesthesia (other than local)
    *00940-FP    Anesthesia for vaginal procedures (including biopsy of labia,     
                            vagina, cervix or endometrium); not otherwise specified
    *57800-FP    Dilation of cervical canal, instrumental (separate procedure)
    *58562-FP    Hysteroscopy, surgical; with removal of impacted foreign body
    *00952-FP    Anesthesia for hysteroscopy and/or hysterosalpingography 
                            procedures

The following diagnosis codes must be billed on the claim form (UB-04 or CMS-1500) in order to be reimbursed by Medicaid:

ICD-9 diagnosis codes:
   *V2512          Encounter for removal of intrauterine contraceptive device
   *V2513          Encounter for removal and reinsertion of intrauterine 
                            contraceptive device
   *V2542          Intrauterine contraceptive device – Checking, reinsertion, or  
                            removal of intrauterine device
Place of Service:
   *22               Outpatient hospital setting
   *11               Office visit

For questions regarding outpatient 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 office billing contact Sylisa Lee-Jackson, Associate Director, Maternity, Plan First/Family Planning and Nurse Midwife Program at 334-353-4599 or via e-mail at sylisa.lee-jackson@medicaid.alabama.gov.