|
Billing & Reimbursement
;
|
TitleWeb Billing guidelines for coverage of intrauterine devices (IUDs)
Professional
December 6, 2018
Page Content Intrauterine devices (IUDs) are a form of long-term contraception used to
prevent pregnancy. Certain IUDs have non-contraceptive uses, for example in the
treatment of medical conditions that result in heavy menstrual bleeding.
The Affordable Care Act (ACA) requires that IUDs used for contraceptive
purposes be covered as a preventive service by healthcare plans. The devices
are eligible for coverage under plans that offer contraceptive coverage/family
planning benefits with no cost-share.
AmeriHealth coverage policies are consistent with the requirements of the
ACA. The appropriate procedure and diagnosis codes must be reported to
distinguish when IUDs are used for contraceptive purposes rather than
non-contraceptive treatment of medical conditions.
Providers should use the Eligibility and Benefits Inquiry transaction on the
NaviNet® web portal to confirm individual member benefits.
Please refer to the table below for details on coverage positions and billing
guidelines for IUDs that may be used for contraceptive and non-contraceptive
indications.
| IUD | HCPCS codes | Is this covered for contraceptive use? | Is this covered for
non-contraceptive* use? |
|---|
| Kyleena? | J7296 | Yes
This is covered for contraceptive use with zero cost-share to the member as
a preventive service when billed with the following ICD-10 diagnosis
codes: Z01.411, Z01.419, Z30.011, Z30.012, Z30.013, Z30.014, Z30.015, Z30.016,
Z30.017, Z30.018, Z30.019, Z30.02, Z30.09, Z30.2, Z30.40, Z30.41, Z30.42,
Z30.430, Z30.431, Z30.432, Z30.433, Z30.44, Z30.45, Z30.46, Z30.49, Z30.8, and
Z30.9. | No
This is considered experimental/investigational and therefore is not covered
for non-contraceptive use. |
| Liletta? | J7297 | Yes
This is covered for contraceptive use with zero cost-share to the member as
a preventive service when billed with the following ICD-10 diagnosis
codes: Z01.411, Z01.419, Z30.011, Z30.012, Z30.013, Z30.014, Z30.015, Z30.016,
Z30.017, Z30.018, Z30.019, Z30.02, Z30.09, Z30.2, Z30.40, Z30.41, Z30.42,
Z30.430, Z30.431, Z30.432, Z30.433, Z30.44, Z30.45, Z30.46, Z30.49, Z30.8, and
Z30.9. | No
This is considered experimental/investigational and therefore is not covered
for non-contraceptive use. |
| Mirena? | J7298 | Yes
This is covered for contraceptive use with zero cost-share to the member as
a preventive service when billed without the following ICD-10 diagnosis
codes: N92.0, N92.1, N92.4, and Z79.890. | Yes
Mirena is covered for non-contraceptive use and will be subjected to a
cost-share based on the member?s benefits when billed with the following
ICD-10 diagnosis codes: N92.0, N92.1, N92.4, and Z79.890. |
| Skyla? | J7301 | Yes
This is covered for contraceptive use with zero cost-share to the member as
a preventive service when billed with the following ICD-10 diagnosis
codes: Z01.411, Z01.419, Z30.011, Z30.012, Z30.013, Z30.014, Z30.015, Z30.016,
Z30.017, Z30.018, Z30.019, Z30.02, Z30.09, Z30.2, Z30.40, Z30.41, Z30.42,
Z30.430, Z30.431, Z30.432, Z30.433, Z30.44, Z30.45, Z30.46, Z30.49, Z30.8, and
Z30.9. | No
This is considered experimental/investigational and therefore is not covered
for non-contraceptive use. |
*Providers should confirm individual member benefits
using the Eligibility and Benefits Inquiry transaction on NaviNet.
Learn more
For more information, refer to the following AmeriHealth medical
policies:
- #07.10.05k: Noncontraceptive Use of the
Levonorgestrel-Releasing Intrauterine System
- #00.06.02w: Preventive Care Services
To view these policies, visit our Medical Policy Portal, select Accept and Go to
Medical Policy Online, and then type the policy name or number in the
Search field.
NaviNet is a registered trademark of NaviNet, Inc.
|
|