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KMAP BULLETIN: Long-Acting Reversible Contraceptives

Date: 04/30/18

KMAP RHC-FQHC BULLETIN 18050 (pdf)

Effective with dates of service on and after February 27, 2018, long-acting reversible contraceptives (LARCs), both intrauterine devices (IUDs) and implants, are no longer included in the Prospective Payment System (PPS) rate. The following codes must be billed using the individual Medicaid provider number rather than the RHC/FQHC number and will be reimbursed on a fee-for-service (FFS) basis.

  • J7297 for Liletta®
  • J7301 for Skyla®
  • J7298 for Mirena®
  • J7296 for Kyleena®
  • J7307 for Nexplanon®
  • J7300 for ParaGard® T380A

Place of service (POS) code 11 (Office) should be used when billing for the LARC. Insertion for the device should be billed using the RHC/FQHC provider number. Providers continue to be reimbursed their encounter rate for insertion of the LARC.

Note: The effective date of the policy is February 27, 2018. The implementation of State policy by the KanCare MCOs may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.

For the changes resulting from this provider bulletin, view the updated Rural Health Clinic/ Federally Qualified Health Center Fee-for-Service Provider Manual, Section 8400, pages 8-7 and 8-8.