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December 2016 Texas Medicaid Provider Procedures Manual

Women’s Health Services Handbook : 3 Health and Human Services Commission (HHSC) Family Planning Program Services : 3.2 Services, Benefits, Limitations, and Prior Authorization : 3.2.7 Drugs and Supplies

3.2.7
The following drug and supply procedure codes may be reimbursed as:
 
Procedure code J1050 with modifier U1 may be reimbursed for services rendered to female clients as medically appropriate for the purpose of contraception. A quantity of 1 must be billed.
For Title XIX family planning services, procedure code J1050 must be billed with a valid family planning diagnosis code.
Procedure code J3490 may be reimbursed when a prescription medication to treat a genital infection is provided to the client. Procedure code A9150 may be reimbursed when a nonprescription medication to treat a monilia infection is provided to the client.

Texas Medicaid & Healthcare Partnership
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