TMPPM 2011 > Gynecological and Reproductive Health, Obstetrics, and Family Planning Services Handbook > Department of State Health Services (DSHS) Titles V, X, and XX Family Planning Services > Services, Benefits, Limitations, and Prior Authorization > Contraceptive Devices and Related Procedures > External Contraceptives
The following procedure codes may be reimbursed separately from the fitting and instruction (procedure code 57170):
57170
$37.37
A4261 (cervical cap)
$50.84
A4266 (diaphragm)
$34.11
