TMPPM 2010 > Gynecological and Reproductive Health, Obstetrics, and Family Planning Services Handbook > Medicaid Title XIX family planning services > Services/Benefits, Limitations, and Prior Authorization > Contraceptive Devices and Related Procedures > External Contraceptives

3.3.5 Contraceptive Devices and Related Procedures

3.3.5.1 External Contraceptives

The following procedure codes may be reimbursed separately from the fitting and instruction (procedure code 57170):

•Procedure code A4261 (cervical cap)

•Procedure code A4266 (diaphragm)