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Postpartum Long-Acting Reversible Contraception Reimbursement Update Effective January 1, 2018

Date: 11/30/17

NH Healthy Families will be updating its reimbursement policies effective January 1, 2018 to permit and encourage insertion of Long-Acting Reversible Contraception (LARC) immediately following a vaginal or cesarean delivery as a separately identified and paid family planning service. Increasing access to LARC immediately postpartum while the member is still inpatient will increase access to contraceptive devices sooner rather than waiting until the first postpartum visit.

Currently, NH Healthy Families utilizes a rate fixed global payment strategy for pregnancy and delivery.

The LARC device is typically bundled into the DRG payment.

Effective January 1, 2018, NH Healthy Families will change its reimbursement to allow payment for the insertion of the LARC and the LARC device.

The following billing guidelines should be followed for physicians:

•        ICD-10 family planning code(s) must be included on the claim

•        Physicians will submit on a CMS 1500 form for the insertion.

•        The procedure code for insertion of the LARC device is 58300 and will be reimbursed at the NH State Medicaid Fee Schedule or contracted rate.

 

The following billing guidelines should be followed for hospitals:

•        Hospitals will submit claims for the LARC devices on a universal billing (UB) inpatient claim

•        The procedure codes for LARC devices are as follows (include NDC code with procedure code where applicable):

o   J7300

o   J7301

o   J7307

o   J7296

o   J7297

o   J7298

•        The above LARC devices will be reimbursed at the NH State Medicaid Fee Schedule rate in addition to the DRG.

* Disclaimer:  Healthcare Common Procedure Coding System (HCPCS) codes are subject to change according to the American Medical Association (AMA) coding updates.

Please contact Provider Services at 1-866-769-3085 with any questions.

Thank you,

NH Healthy Families