7/31/2015
PDF Version
NOTE: THIS ALERT REPLACES THE ALERT DATED JULY 14, 2015
TO: All Family Planning Providers (Physicians, FQHC, IRHC, PBRC), Hospitals, Obstetricians-Gynecologists, and Plan First Providers
Effective for dates of service April 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. The following procedure will be used to bill for a Liletta IUD.
· Effective for dates of service April 1, 2015 through July 31, 2015, providers will use an Unclassified Drug code to bill for a Liletta IUD. The following HCPCS Code is applicable:
o J3490 Unclassified Drug
· Effective for dates of service August 1, 2015, and thereafter, providers will use the following HCPCS Code to bill for a Liletta IUD:
o J7302 Liletta IUD
· Effective for dates of service August 1, 2015, and thereafter, an “FP” modifier must be used to bill for a Mirena IUD. The following HCPCS Code is applicable:
o J7302-FP Mirena IUD
The following CPT codes are applicable:
o 58300 Insertion of intrauterine device
o 58301 Removal of intrauterine device
This procedure is only covered in an office setting. The place of service must be indicated on the CMS 1500 claim form in order to be reimbursed by Medicaid. The following Place of Service Code is applicable:
o 11 Office visit
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. The following ICD-9 Diagnosis Codes are applicable:
o V2502 Initiation of other contraceptive measures
o V2511 Encounter for insertion of intrauterine contraceptive device
o V2512 Encounter for removal of intrauterine contraceptive device
o V2513 Encounter for removal and reinsertion of intrauterine contraceptive device
o V2542 Checking of intrauterine contraceptive device
ICD-10 diagnosis codes should be used for claims submitted with dates of service October 1, 2015, or thereafter. The following ICD-10 Diagnosis Code are applicable:
o Z30014 Encounter for initial prescription of intrauterine
contraceptive device
o Z30430 Encounter for insertion of intrauterine contraceptive
device
o Z30431 Encounter for routine checking of intrauterine
contraceptive device
o Z30432 Encounter for removal of intrauterine
contraceptive device
o Z30433 Encounter for removal and reinsertion of intrauterine
contraceptive device
For questions regarding billing for the Liletta or Mirena IUDs, contact Ruth Harris, Program Manager, Plan First Program at 334-353-3562 or via e-mail at ruth.harris@medicaid.alabama.gov.
The billing policy for unclassified J codes can be found on the Alabama Medicaid Agency’s Website at http://www.medicaid.alabama.gov/documents/6.0_Providers/6.7_Manuals/6.7.1_Provider_Manuals_2015/
6.7.1.3_July_2015/Jul15_H.pdf.