KMAP BULLETIN: Long-Acting Reversible Contraceptive Billing Allowance – Post Partum

Date: 12/02/22

KMAP GENERAL BULLETIN 22311 (PDF)

Effective with dates of service on and after January 1, 2023, longacting reversible contraceptives (LARCs), both IUDs and implants, are no longer included in the Diagnosis Related Group (DRG) rate. A hospital will bill the Medicaid fiscal agent or the Managed Care Organization (MCO) and be reimbursed on a feefor-service basis. The LARC must be billed separately than the inpatient claim on a UB04 Form with type of bill 131or 851 using the acute hospital National Provider Identifier (NPI). The professional provider or surgeon will bill on a CMS 1500 Form utilizing procedure code 58300 or procedure code 11981.

Currently active J-codes for LARCs are as follows:

J7296

J7297

J7298

J7300

J7301

J7307

An exception to the inpatient/outpatient claims edits for same day billing will be allowed for the LARC procedure code.

Note: The effective date of the policy is January 1, 2023. The implementation of State policy by the KanCare managed care organizations (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.