Reimbursement Rate Update for Long Acting Reversible Contraceptives (LARCs)

PROVIDER ALERT

Due to a recent increase in pricing of several Long Acting Reversible Contraceptives (LARCs), effective Jan. 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) has updated the reimbursement rates. Sales tax coverage has been included.

HCPCS Name Current Rate New Rate
J7300 ParaGard® $ 804.50 $ 804.50
J7301 Skyla® $ 707.96 $ 778.05
J7307 Nexplanon® $ 839.91 $ 923.06
J7297 Liletta® $ 680.40 $ 680.40
J7298 Mirena® $ 882.35 $ 934.41
 

Claims for Kyleena should be billed with J3490 code, and it will be manually priced until a permanent code is assigned.

Any future changes to the reimbursement rate for these products will be communicated through the standard fee schedule update process and may not be communicated via Medicaid bulletin or alert.

This alert applies to services provided to beneficiaries who are enrolled in fee-for-service Medicaid. South Carolina Medicaid managed care organizations (MCOs) should be contacted directly for information on their LARCs coverage.

If you have any questions regarding this alert, please contact the Provider Service Center at (888) 289-0709.

Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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