Provider Alert! Long Acting Reversible Contraception (LARC) Billing Changes

Provider Alert! Long Acting Reversible Contraception (LARC) Billing Changes

To: All Providers and Facilities
Subject: Long Acting Reversible Contraception (LARC) Billing Changes

Recent changes at Health and Human Services Commission (HHSC) has improved the accessibility of LARC devices for Medicaid members.

HHSC is currently working to add ParaGard, Nexplanon and Liletta to the Medicaid Vendor Drug Program formulary. More information on these products and the process to order will be supplied as these are added. Once added, providers may choose to continue to “buy and bill” or they may choose to receive the product through the specialty pharmacy option such as with Mirena and Skyla today.

Effective January 1, 2016 LARC devices will be a benefit when administered in a hospital setting in addition to the diagnosis related group payment when a LARC device is inserted immediately postpartum. Facilities will be paid an outlier payment for the following codes when a LARC device is inserted immediately postpartum: J7300, J7301, J7302, J7307. Hospitals who obtain the LARC device via the 340B drug program will need to use the U8 modifier on the claim line.

Effective January 1, 2016, Federally Qualified Health Centers (FQHC) will receive an additional payment for J7300, J7301, J7302, or J7307 in addition to the contracted FQHC encounter payment. FQHC’s who obtain the LARC device via the 340B drug program will need to use the U8 modifier on the claim line.

If you have any questions or need additional information about LARC billing, please contact Provider Relations by calling 832-828-1009-8 or toll-free 1-800-731-8527.

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