TO: All Family Planning Providers (physicians, FQHC, IRHC, PBRHC), Hospitals, Obstetricians-Gynecologists, and Plan First Providers
RE: Coverage of Liletta IUD under the Plan First/Family Planning Program
Effective for dates of service August 1, 2015, and thereafter, the Alabama Medicaid Agency will begin coverage of the Liletta Intrauterine Device (IUD). Currently, Liletta is approved for only 3 years of continuous use. Providers will use HCPCS Code J7302 to bill for a Liletta IUD, the same HCPCS code currently used to bill for a Mirena IUD.
Effective for dates of service August 1, 2015, and thereafter, providers will use HCPCS Code J7302 with modifier FP (J7302- FP) to bill for a Mirena IUD.
The following HCPCS codes are applicable:
• J7302 Liletta IUD
• J7302-FP Mirena IUD
The following CPT codes are applicable:
• 58300 Insertion of intrauterine device
• 58301 Removal of intrauterine device
The following Diagnosis Codes must be billed in conjunction with the above HCPCS and CPT codes in order to be reimbursed by Medicaid. ICD-9 diagnosis codes should be used for claims submitted with dates of service on or prior to September 30, 2015.
ICD-9 Diagnosis Codes:
• V2502 Initiation of other contraceptive measures
• V2511 Encounter for insertion of intrauterine contraceptive device
• V2512 Encounter for removal of intrauterine contraceptive device
• V2513 Encounter for removal and reinsertion of intrauterine contraceptive device
• V2542 Checking of intrauterine contraceptive device
ICD-10 diagnosis codes should be used for claims submitted with dates of service October 1, 2015, or after:
ICD-10 Diagnosis Code:
• Z30014 Encounter for initial prescription of intrauterine contraceptive device
• Z3043 Encounter for insertion of intrauterine contraceptive device
• Z30431 Encounter for routine checking of intrauterine contraceptive device
• Z30432 Encounter for removal of intrauterine contraceptive device
• Z30433 Encounter for removal and reinsertion of intrauterine contraceptive device
Place of service:
• 11 Office visit
For questions regarding billing for the Liletta or Mirena IUDs, contact Sylisa Lee-Jackson, Associate Director, Maternity, Plan First/Family Planning and Nurse Midwife Programs at 334-353-4599 or via email at sylisa.lee-jackson@medicaid.alabama.gov.