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4.3 Services, Benefits, Limitations, and Prior Authorization
This section contains information about family planning services funded through Titles V, X, and XX funding sources including:
• 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 ligation, vasectomy, and anesthesia for sterilization)
For Title V, X, or XX claims, providers are encouraged to include one of the following family planning diagnosis codes on the claim in conjunction with all family planning procedures and services:
One of the diagnosis codes in this table may 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.
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