Hospital Outpatient HCPCS1 Code

C9399 Unclassified Drugs or Biologicals

CPT Code 17999 Unlisted procedure, skin, mucous membrane and subcutaneous

CPT Code 11981 Insertion of single non-biodegradable implant

CPT Code 11982 Removal of single non-biodegradable implant

CPT Code 11983 Removal and re-insertion of single non-biodegradable implant

The diagnostic coding will vary, but usually will be selected from the Encounter for Contraceptive Management code series – V25 in ICD-9-CM or Z30 in ICD-10-CM. These codes are:

V25.5 Encounter for contraceptive management, insertion of implantable subdermal contraceptive or Z30.018 Encounter for initial prescription of other contraceptives in ICD-10-CM.

V25.43 Surveillance of previously prescribed contraceptive method; implantable subdermal contraceptive or Z30.49 For checking, reinsertion, or removal of the implant in ICD-10-CM.


Q: Are contraceptive management services included in postpartum care?

A: UnitedHealthcare will consider separate reimbursement for contraceptive management services when provided during the postpartum period only when submitted with CPT codes 11981 (insertion, non-biodegradable drug delivery implant), 57170 (diaphragm or cervical cap fitting with instructions), or 58300 (insertion of intrauterine device, IUD).

State Effective Date Payment Strategy Policy Description Implementation Alabama April 2014 Reimbursement of LARC insertion immediately postpartum in the inpatient hospital setting or outpatient practice setting.

1. Covers the cost of the LARC device/drug implant as part of the hospital’s cost, and the insertion of the device/drug implant is billable to Medicaid when the insertion occurs immediately after a delivery before discharge from an inpatient setting.

2. Covers the cost of the LARC device/drug implant as part of the hospital’s cost, and insertion is billable to Medicaid when the insertion is provided in an outpatient setting after delivery and immediately after discharge from an inpatient setting.

1. Inpatient: the hospital must use an International Classification of Diseases (ICD- 9) delivery diagnosis code within the range 630 – 67914 and must use the ICD-9 surgical code 69.7 (insertion contraceptive device) to document LARC services provided after the Delivery.

2. Postpartum LARC in the outpatient hospital setting immediately after discharge from inpatient settings, should be billed on a UB-04 claim form using one code from each of the following with family planning modifier (FP):

• 58300 Insertion of IUD
• 11981-FP Insertion, non-biodegradable drug delivery implant
• 11983-FP Removal with reinsertion

 ICD-9 diagnosis codes:

• V255 Encounter for contraceptive management, insertion of implantable  subdermal contraceptive
• V2511 Insertion of intrauterine contraceptive device
• V2502 Initiate contraceptive NEC
• V251 Insertion of IUD Physician bill on CMS 1500 form using the same coding as above and also indicate Place of Service:
• 21 Inpatient hospital setting
22 Outpatient hospital setting

Massachusetts October 2014 


Reimbursement of LARC insertion immediately postpartum in the inpatient hospital setting.

Comprehensive LARC coverage for outpatient practice settings such as hospital outpatient

1. Hospitals are reimbursed for the provision of the LARC device. The insertion procedure is reimbursed directly through the claim payment, while the device is reimbursed indirectly as part of the hospital’s base rate. The device is reported on the annual cost report as a supply, and those costs are incorporated

1. MassHealth payment methodology recently adopted the APR DRG model by 3M Health Information Systems, which weights every service that is entered on the claim. The device is accounted for on the annual hospital cost report, and these costs are incorporated into the hospital’s overall provider base rate departments or family planning agencies. into the hospital’s provider base rate calculation.

2. Hospital-based practitioners bill the professional claim for surgical procedure through the hospital. The professional claim for hospitalbased providers does not include the device.

3. Community-based practitioners are reimbursed separately for the professional service of inserting the device as well as the device itself (if supplied by the physician) on the claim.

2. Family planning agencies that participate in MassHealth are reimbursed for the LARC device and insertion when billed with the appropriate code: 11981 – Insertion, non-biodegradable drug delivery implant 11983 – Removal with reinsertion, nonbiodegradable drug delivery implant 58300 – Insertion of intrauterine device (IUD) J7301 Levonorgestrel-releasing intrauterine contraceptive system, 13.5 mg J7302 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg S4989 Contraceptive intrauterine device, including implants and supplies

3. The community based practitioner is reimbursed separately for the professional service of inserting the device as well as for the device itself if supplied by the physician. Billing is done on a professional claim and paid according to a fee schedule.

4. Regular HCPCS updates to capture new device availability

Montana January 2015 Reimbursement of LARC insertion immediately postpartum in the inpatient hospital setting. LARCs inserted at the time of delivery are excluded from the PPS inpatient APR-DRG group. Montana Medicaid is allowing PPS hospitals to unbundle the LARC device and the insertion from the inpatient delivery claim. These services can now be billed as an outpatient service on a 13X type of bill, and will be paid at the OPPS rates. The following

HCPCS/CPT codes are allowed:

• J7300
• J7301
• J7302
• J7307
• 11981
• 58300

New Mexico 2014

Reimbursement of LARC insertion immediately postpartum in the inpatient hospital setting.

1. Practitioners receive reimbursement for insertion in the hospital and for the device if the practitioner supplied it.

2. Hospitals are reimbursed for the  device as a medical supplycompany.

3. Insertion within the same surgery as a Cesarean section is considered incidental to the surgery, and therefore not reimbursed. However, the practitioner will still be reimbursed for the device.

1. Hospitals are reimbursed for the device if:

• The facility is enrolled in the New Mexico Medicaid program as a medical supplier (provider type 414); a separate NPI is not required.

• Date of service is the same as the DRG date of service.

• Hospital’s professional claim (837P electronic claim or CMS-1500 form) is submitted as a medical supply company.

• Claim includes the appropriate HCPCS procedure code and NDC number for the device.

Place of service (POS) code is 21 (inpatient hospital).

• The billing taxonomy number for a medical supplier appears on the claim (typically 332BOOOOOX).

2. Practitioners are reimbursed for the device and insertion if:

• Billed on the same professional claim (837P electronic or CMS-1500 paper) as the delivery procedure.

• Claim indicates the device HCPCS code and NDC number.

• Claim indicates procedure CPT codes (most likely 58300 or 11981).

• Claim indicates the POS as 21 (inpatient hospital).



Documentation Requirements   
Medicare will not cover the excess cost for the more expensive of these medications that have the same overall clinical response as another already in widespread use. The patient will not be responsible for the difference in price between the two drugs without an acceptable advanced beneficiary notification (ABN).

Any administration of these drugs in the absence of an acceptable clinical diagnosis (see above section) will be denied as not reasonable and necessary

The manufacturers strongly recommend that the provider should attempt to adhere closely to the schedule (every four weeks, 12 weeks, etc.), though they note that a delay of a few days is permissible.

Because CPT codes 11981-11983 may be used for implants other than J9219, J9225, and J9226, this A/B MAC will not limit these procedures to just these two HCPCS codes and the diagnoses in this LCD. Similarly, 96372 and 96402 will be allowed for indicated diagnoses beyond those in this LCD.
Chart documentation must support the diagnosis on the claim, and be made available to Medicare upon request.

For one-year implants, the chart must document and justify the clinician?s belief that the patient?s life expectancy is at least one year.

The HCPCS/CPT code(s) may be subject to Correct Coding Initiative (CCI) edits. This policy does not take precedence over CCI edits. Please refer to the CCI for correct coding guidelines and specific applicable code combinations prior to billing Medicare.

When the documentation does not meet the criteria for the service rendered or the documentation does not establish the medical necessity for the services, such services will be denied as not reasonable and necessary.

When requesting a written redetermination (formerly appeal), providers must include all relevant documentation with the request.