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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 2. Medicaid Title XIX family planning services : 2.2 Services, Benefits, Limitations, and Prior Authorization : 2.2.5 Contraceptive Devices and Related Procedures : 2.2.5.3 Contraceptive Capsules

2.2.5.3
The contraceptive capsule and the implantation of the contraceptive capsule may be reimbursed using procedure code J7307 and may be reimbursed once every 3 rolling years.
Procedure code 11981 may be reimbursed for the insertion of the implant device when it is billed with a family planning diagnosis code.
Progesterone-containing subdermal contraceptive capsules (Norplant) were previously used for birth control. Although subdermal contraceptive capsules are no longer approved by the Food and Drug Administration (FDA), the removal of the implanted contraceptive capsule may be considered for reimbursement with procedure code 11976 (removal). Procedure code 11976 may be reimbursed when it is billed with diagnosis code V2543.

Texas Medicaid & Healthcare Partnership
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