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20.7.6.1 Dispensing Medication
Family planning providers have a choice of dispensing family planning drugs and supplies directly to the client and billing TMHP, or giving clients a prescription to take to a pharmacy. Family planning drugs and supplies that are dispensed directly to the client are billed to TMHP or a Medicaid managed care organization (MCO). Family planning providers may dispense up to a one year supply of contraceptives in a 12 month period using procedure codes J7303, J7304, or S4993. Providers must include the appropriate family planning diagnosis code.
Pharmacies under the Vendor Drug Program are allowed to fill all prescriptions as prescribed for up to a six month supply. Providers who also contract with DSHS for Title V, X, or XX should refer to the DSHS Title V, X, and XX Family Planning Policy Manual for additional guidance on dispensing medication to Title V, X, or XX clients.
Procedure code J3490 may be billed when a prescription medication to treat a genital infection is provided to the client. Procedure code A9150 with modifier FP may be billed when a nonprescription medication to treat a monilia infection is provided to the client. Family planning drugs and supplies are exempt from the three prescriptions-per-month rule. Additionally, pharmacies under the Vendor Drug Program contract are allowed to fill the prescription for up to six months at a time.
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