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December 2016 Texas Medicaid Provider Procedures Manual

Clinics and Other Outpatient Facility Services Handbook : 7 Rural Health Clinic : 7.2 Services, Benefits, Limitations, and Prior Authorization : 7.2.1 Services Rendered by the RHC Facility Provider : 7.2.1.4 * Family Planning Services

7.2.1.4
RHC facility providers may be reimbursed for family planning services using their RHC NPI with the appropriate benefit code.
If the appropriate benefit code is not included, the service will process as informational only and will not be reimbursed.
Family planning services must be submitted with the most appropriate evaluation and management (E/M) procedure code and the most appropriate family planning diagnosis code:
 
* Family planning services performed in the RHC setting must be billed with the appropriate modifier: AM, SA, or U7.
RHC providers may receive an encounter rate when submitting claims with procedure code T1015, in addition to a flat “add on” fee for the Long-Acting Reversible Contraception (LARC) procedure codes listed above.
Refer to:
Subsection 4.2, “Services, Benefits, Limitations, and Prior Authorization” in this handbook for the list of family planning diagnosis codes.
Subsection 6.3.5, “Modifiers” in Section 6, “Claims Filing” (Vol. 1, General Information) for a definition of modifiers.
Section 9, “Physician,” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks).
Section 5, “THSteps Medical,” in the Children’s Services Handbook (Vol. 2, Provider Handbooks).
Section 2, “Medicaid Title XIX Family Planning Services,” in the Gynecological and Reproductive Health and Family Planning Services Handbook (Vol. 2, Provider Handbooks).
Subsection 8.8.2.2, “HMO Copayments” in “Section 8: Third Party Liability" (Vol. 1, General Information) for information about HMO copayments.
Subsection 9.2.56.1.2, “Preventive Care Visits” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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