TMPPM 2011 > Gynecological and Reproductive Health, Obstetrics, and Family Planning Services Handbook > Medicaid Title XIX family planning services > Services, Benefits, Limitations, and Prior Authorization

2.3 Services, Benefits, Limitations, and Prior Authorization

This section includes information on family planning services funded through Title XIX Medicaid. WHP, which is also a benefit of Title XIX, is covered in Section 3, "Women's Health Program (Title XIX Family Planning)" in this handbook.

Family planning services are preventive health, medical, counseling, and educational services that assist individuals in managing their fertility and achieving optimal reproductive and general health. Title XIX services include:

•Family planning annual exams

•Other family planning office or outpatient visits

•Laboratory procedures

•Radiology services

•Contraceptive devices and related procedures

•Drugs and supplies

•Medical counseling and education

•Sterilization and sterilization-related procedures (i.e., tubal implants, tubal ligation, vasectomy, and anesthesia for sterilization)

Providers must use one of the following diagnosis codes in conjunction with all family planning procedures and services:

One of the diagnosis codes in this table must be included in Block 24 E of the CMS-1500 claim form referencing the appropriate procedure code. The choice of diagnosis code must be based on the type of family planning service performed.

Note: Title XIX family planning services are exempt from the limited program and rules.