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December 2016 Texas Medicaid Provider Procedures Manual

Gynecological, Obstetrics, and Family Planning Title XIX 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. Providers must use modifier U8 when submitting claims for a contraceptive device purchased through the 340B Drug Pricing Program.
Procedure code 11981 may be reimbursed for the insertion of the implant device when it is billed with a family planning diagnosis code.
Procedure code 11983 may be reimbursed for the removal with reinsertion 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 or 11982.

Texas Medicaid & Healthcare Partnership
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