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Family Planning Services
20.1 Overview 20-3
20.2 Family Planning Providers 20-3
20.2.1 Women's Health Program 20-3
20.3 Provider Enrollment 20-3
20.3.1 Title XIX Enrollment 20-3
20.3.2 Title V, X, and XX Contractors 20-4
20.4 Guidelines for Family Planning Providers 20-4
20.5 Family Planning Claim Billing 20-4
20.5.1 Family Planning and Third Party Insurance 20-4
20.5.2 Claims Information 20-4
20.5.2.1 Benefit Code 20-5
20.5.2.2 National Drug Codes (NDC) 20-5
20.5.2.3 Medicaid Managed Care Claims 20-5
20.5.2.4 Billing HMOs for Out-of-Network Family Planning Services 20-5
20.5.2.5 Title X Encounter Filing 20-5
20.5.2.6 Electronic TexMedConnect Claims in a Title X-Supported Clinic 20-6
20.5.2.7 Paper Form: Family Planning 2017 Claim Forms in a
Title X-Supported Clinic 20-6
20.5.2.8 Other Electronic Claims in the Title X-Supported Clinic 20-6
20.5.2.9 Title X Payments 20-6
20.5.3 Filing Deadlines 20-6
20.5.4 Claim Appeals 20-7
20.5.4.1 Two Appeal Methods to TMHP for Family Planning Titles V, X, and XX 20-7
20.5.4.2 Electronic Appeal Submission 20-7
20.5.4.3 Disallowed Appeals 20-7
20.5.5 Billing Procedures for Non-Family Planning Services Provided During a
Family Planning Visit 20-7
20.5.6 Limited Medicaid Coverage 20-7
20.5.6.1 Family Planning Services for Undocumented Aliens, Legalized Aliens 20-7
20.6 Diagnosis Codes 20-7
20.7 Procedure Codes and Reimbursement Amounts 20-8
20.7.1 Family Planning Annual Exams 20-8
20.7.2 Other Family Planning Office or Outpatient Visits 20-8
20.7.2.1 Limitations 20-8
20.7.3 Laboratory Procedures 20-9
20.7.3.1 Laboratory Procedures-Title V Only 20-9
20.7.3.2 Laboratory Procedures-Title XlX Only 20-9
20.7.3.3 Laboratory Procedures-Titles V and XX 20-9
20.7.4 Radiology 20-10
20.7.5 Contraceptive Devices and Related Procedures 20-10
20.7.6 Drugs and Supplies 20-10
20.7.6.1 Dispensing Medication 20-11
20.7.6.2 Injection Administration-Title XIX Only 20-11
20.7.7 Medical Counseling and Education 20-11
20.7.7.1 Instruction in Natural Family Planning
Methods (Per Session)-Title V, XIX, and XX 20-11
20.7.7.2 Introduction to Family Planning in Hospital
Setting/Auspices-Title V and XX Only 20-11
20.7.7.3 Nutritionist Visit-Title V Only 20-11
20.7.7.4 Method-Specific Education/Counseling-Title V and XX Only 20-11
20.7.7.5 Problem Counseling-Title V and XX Only 20-11
20.7.7.6 Teen Group Counseling - Title XX Only 20-11
20.7.7.7 Initial Patient Education - Title V and XX Only 20-12
20.7.8 Sterilization and Sterilization-Related Procedures 20-12
20.7.8.1 Incomplete Sterilizations-Title V and XX only 20-12
20.7.8.2 Tubal Ligation 20-12
20.7.8.4 Anesthesia for Sterilization 20-13
20.7.8.5 Facility Fees for Sterilization 20-13
20.7.9 Sterilization Consent Form and Instructions 20-13
20.7.9.1 Sterilization Consent Form Instructions 20-13
20.7.9.2 Required Fields 20-13
20.7.10 Claim Filing Resources 20-14
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