Reimbursement Changes regarding Intrauterine Devices (IUDs) and Implantable Contraceptives
||Participating Advanced Practice Nurses, Encounter Rate Clinics (ERCs), Federally Qualified Health Centers (FQHCs), Local Education Agencies (LEAs), Local Health Departments, Pharmacies, Physicians, Rural Health Clinics (RHCs) and School Based/Linked Health Centers |
||June 1, 2012|
||Reimbursement Changes regarding Intrauterine Devices (IUDs) and Implantable Contraceptives|
The purpose of this notice is to inform providers of a change in policy related to billing of IUDs and implantable contraceptives. In addition, this notice provides instructions on handling unused IUDs when an IUD was ordered for a patient through the pharmacy system, but was not inserted for that patient.
Effective June 15, 2012, the department will no longer allow IUDs or implantable contraceptives to be billed through the pharmacy point-of-sale system. The provider who is inserting the IUD or contraceptive must purchase the product and bill the department for both the product and the insertion procedure. The family planning indicator and modifier must be used to identify both the product and the procedure as family planning services.
When a provider orders an IUD from a pharmacy, for a Medical Assistance patient, the pharmacy bills the department for the IUD under that patient’s Recipient Identification Number (RIN). Once delivered to the provider’s office, that IUD cannot be returned to the pharmacy. The department is aware that some providers currently have unused IUDs that were ordered for Medical Assistance patients, but the patients for whom the IUDs were ordered did not present to have the IUD inserted. Providers have requested guidance from the department on the handling of those unused IUDs. In order to reduce waste, providers should use those IUDs in other Medical Assistance patients. The provider must maintain a log that tracks those “unused” IUDs. For each “unused” IUD, the log entry must include the name and RIN of the patient for whom the IUD was ordered, and the name and RIN of the patient in whom the IUD was inserted, along with the date of insertion. Providers must maintain copies of the IUD logs in accordance with record retention requirements and must submit newly generated IUD logs to the Bureau of Comprehensive Health Services on a quarterly basis. Requiring providers to purchase and bill the department for the IUD and its insertion will eliminate the “unused” IUD issue that providers have been experiencing.
Questions regarding this notice and quarterly provider IUD logs should be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565 and/or the address indicated above.
Theresa A. Eagleson, Administrator
Division of Medical Programs