Long-acting reversible contraception (LARC), Medicaid

Applies to:

Medicaid

Definition:

Long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action.

LARC billing

Priority Health aligns with  Michigan Department of Health and Human Services (MDHHS) practices in reimbursing for LARC services for Medicaid members. MDHHS reimburses hospitals for immediate postpartum long-acting reversible contraception (LARC) implants and intrauterine devices (IUDs) separate from the maternity Diagnosis Related Group (DRG).

All rendering providers must be associated with the hospital NPI within their CHAMPS provider enrollment file.

Hospital billing

Hospitals must bill a separate invoice on the CMS-1500 paper claim form to be reimbursed.

• Use the hospital NPI as the billing NPI.
• Use the rendering NPI of the physician that performed the insertion.
• Place of service is 21 - Inpatient Hospital.
• Use the National Drug Code (NDC) for the device.
• Bill the HCPCS procedure code for the device: J7296, J7297, J7298, J7300, J7301, J7307
• Use modifier U6, Medicaid Level of Care 6.

Professional billing

Professional providers bill for the insertion of the device with their group NPI and the rendering NPI reported on the electronic professional 837P or CMS-1500 paper claim form. 

References

Oct. 1, 2018 MDHHS memo annoucing this new reimbursement