Revised Family Planning Examination/Visits

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Effective immediately, the South Carolina Department of Health and Human Services (SCDHHS) no longer requires a physical examination during an initial Family Planning visit in order to prescribe hormonal contraception. This applies to all Medicaid beneficiaries who receive Family Planning services under fee for service and under Check-up. The services that must take place during patient visits are outlined in the following table.

 

 

 

Initial Visit

 

Annual Visit

 

Periodic Visit

Must Include:

  • Medical History
  • Reproductive Life Plan
  • Sexual Health Assessment
  • Height
  • Blood Pressure
  • Weight
  • Documentation of any treatment and/or counseling including administration and/or issuance of contraceptive supplies
  • Counseling and education, as necessary, regarding pregnancy prevention and/or sexually transmitted diseases
  • Medical History
  • Sexual Health Assessment
  • Weight
  • Blood Pressure Check
  • Symptom appraisal, as needed
  • Documentation of any treatment and/or counseling including administration and/or issuance of contraceptive supplies
  • Counseling and education, as necessary, regarding pregnancy prevention and/or sexually transmitted diseases

Females

  • Breast exam,

annually if >19 years of age, then

every 3 years if 20-39 years of age

Cervical Cytology,

every 3 years if >21 years of age

every 5 years if >30 years of age

 

Males

  • Genital exam, to include inspection of skin, hair and perianal region, as well as palpation of inguinal nodes, scrotum and penis
  • Weight
  • Blood Pressure
  • Interim History
  • Documentation of any treatment and/or counseling including administration and/or issuance of contraceptive supplies

Should Include:

Females

Breast exam, >20 years of age

Cervical Cytology, >21 years of age

 

Males

Genital exam, to include inspection of skin, hair and perianal region, as well as palpation of inguinal nodes, scrotum and penis

  • Lab Tests
  • Issuance of Birth Control supplies or Prescription
  • Symptom appraisal, as needed
  • Lab tests
  • Issuance of birth control supplies or prescription

 

The revised language is consistent with updated standards released by the Centers for Disease Control.

 

Billing procedures and codes have not been changed. For a complete copy of the most current policy, please refer to the Physician, Laboratories and Other Medical Professionals Provider Manual located on the SCDHHS website at http://www.scdhhs.gov .

 

If you have any questions regarding this bulletin, please contact the SC Provider Service Center at 1 (888) 289-0709. Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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