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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 : 3.3.6 Drugs and Supplies

Procedure codes A4267, A4268, A4269, J1055, J7303, J7304, and S4993 may be reimbursed for drugs and supplies.
Procedure codes A4268, A4269, and S4993 may be reimbursed when they are billed with one of the following diagnosis codes:

Texas Medicaid & Healthcare Partnership
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