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2012 Texas Medicaid Provider Procedures Manual

Gynecological and Reproductive Health and Family Planning Services Handbook : 4. Department of State Health Services (DSHS) Family Planning Program Services : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.5 Contraceptive Devices and Related Procedures

The following procedure codes may be reimbursed separately from the fitting and instruction (procedure code 57170):
A4261 (cervical cap)

Texas Medicaid & Healthcare Partnership
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