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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 3. Women’s Health Program (Title XIX Family Planning) : 3.3 Services, Benefits, Limitations, and Prior Authorization : 3.3.5 Contraceptive Devices and Related Procedures

3.3.5
The following procedure codes may be reimbursed for contraceptive devices and related procedures:
Procedure code 11976 may be reimbursed when it is billed with diagnosis code V2543.
Procedure code 11981 may be reimbursed when it is submitted with the most appropriate family planning diagnosis code.
Procedure codes A4261 and A4266 may be reimbursed when they are billed with one of the following diagnosis codes:
Procedure code J7302 may be reimbursed when it is billed with one of the following diagnosis codes:
Procedure codes J7300 or J7302 must be billed with procedure code 58300 on the same date of service to receive reimbursement for the IUD and the insertion of the IUD.
An E/M procedure code will not be reimbursed when it is billed with the same date of service as procedure code 58301, unless the E/M visit is a significant, separately identifiable service from the removal of the IUD. If the E/M visit occurs on the same date of service as the removal of the IUD, modifier 25 may be used to indicate that the E/M visit was a significant, separately identifiable service from the procedure, and documentation must be included in the client's medical record that indicates either the key components (history, physical examination, and medical decision making) or time spent counseling.

Texas Medicaid & Healthcare Partnership
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