Long Acting Birth Control Device provided in a Hospital Setting

 

Effective for dates of services on or after March 1, 2012, the South Carolina Department of Health and Human Services (SCDHHS) is updating its policy to include reimbursement for long acting birth control devices provided in a hospital setting.  The coverage of this service will be considered an add-on benefit and will not be included in the Diagnostic Related Group (DRG) reimbursement system.  The following codes will now be covered separately:

 

  • J7300 Intrauterine copper contraceptive
  • J7302 Levonorgestrel – release IU contraceptive 52 mg
  • J7306 Levonorgestrel (contraceptive) Implant system, including implants and supplies
  • J7307 Etonogestrel (contraceptive) implant system, including implant and supplies.
  • A4264 Permanent implantable contraceptive intratubal occlusion device(s) and delivery system.

 

Physician supplied long acting birth control:

Physicians that are billing for the device or supplies listed above must indicate the place of service Inpatient Hospital (21) on the CMS 1500 claim form.  Providers will continue using the family planning modifier (FP).  The claims that are being submitted by the physician will be reimbursed to the physician, with payment based on the South Carolina Medicaid fee schedule. 

 

 

SCDHHS will only make one reimbursement to either the provider or the hospital which ever has provided the long acting birth control supply or device. 

 

This bulletin affects the policy for fee-for-service and the Medical Home Network (MHN).  Please contact the appropriate Managed Care Organization (MCO) for their coverage policy. 

 

For a complete copy of these policy changes, please refer to the most current version of the Hospital Services and Physicians, Laboratory and Other Medical Professionals manuals located on the SCDHHS website at http://www.scdhhs.gov.  If you have any questions concerning this bulletin, please contact your Program Manager in the Office of Hospitals, Dental, Transportation and Durable Medical Equipment at (803) 898-2665 or the Office of Physician, Pharmacy, and Enhanced Care Services at (803)-898-2660.  Thank you for your continued support and participation in the South Carolina Healthy Connections Medicaid Program.

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