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Department of Human Services Department of Human Services  
 
Abortion Services

Revised: 09-26-2013



This section includes MHCP coverage and billing policy for induced abortions and abortion related services. Refer to Overview page for links to other related services.


Eligible Providers
• Ambulatory surgery centers
• Certified registered nurse anesthetist
• Family planning agency
• Hospitals
• Indian health facility provider
• Nurse practitioner
• Nurse midwife
• Physician assistant
• Physicians

Eligible Recipients
• Recipients must be covered under Medical Assistance (MA) for the month the abortion for health/therapeutic reasons is performed
• MA for pregnant women requires a woman complete the application and meet income/resource guidelines
• Women enrolled in MinnesotaCare who seek an abortion for health/therapeutic reasons must apply (DHS-2087A) for MA using the MHCP Application (DHS-3417)
• Coverage can be retroactively applied for up to three months

Medical Assistance (MA) Recipients
Payment for induced abortions and abortion-related services provided to MA recipients is available under the following conditions:

• The woman suffers from a physical disorder, physical injury, or physical illness, including a life-endangering physical condition caused by, or arising from the pregnancy itself that would, as certified by a physician, place the woman in danger of death unless the abortion is performed
• Pregnancy resulted from rape
• Pregnancy resulted from incest
• Abortion is being done for other health/therapeutic reasons

MinnesotaCare Recipients
Payment for induced abortions and abortion related services provided to MinnesotaCare recipients is available under the following conditions:

• Pregnancy resulted from rape
• Pregnancy resulted from incest
• Abortion is being done to prevent substantial and irreversible impairment of a major bodily function
• Continuation of the pregnancy would endanger the woman’s life

Women enrolled in MinnesotaCare seeking an abortion for other health/therapeutic reasons must apply for and be covered by MA prior to the procedure. MA eligibility can be made retroactive for up to three months.


Authorization Requirements
Abortion services performed out-of-state/out of the recipient’s local trade area require prior authorization.


Covered Services
Abortion Related Services
Abortion-related services are services directly related to performing an induced abortion. Examples of abortion related services include:

• Hospitalization when the abortion is performed in an inpatient setting
• The use of a facility when the abortion is performed in an outpatient setting
• Counseling related to the abortion
• General anesthesia or conscious sedation provided with the abortion. Local and regional anesthesia, including nerve blocks, administered by the attending physician, are considered integral to the procedure and are not separately billable
• Drugs provided during or directly after the abortion
• Treatment of infection or other complications as a result of the abortion (including treatment for an incomplete abortion)
• Uterine ultrasound following an abortion
• Abortion service codes (surgical induced abortion and medical abortion service codes)
• Supplies (trays, Laminaria, etc.)
• Drugs (anti-anxiety, narcotics, anesthetics, antibiotics, etc.)

Non-Abortion Related Services
Services that are not abortion related include:

• A history and physical exam performed on the same day as the procedure
• Tests for pregnancy and venereal disease
• Blood tests
• Rubella titre
• Gonadotropin levels (hCG)
• Hemoglobin and hematocrit
• The GAM (TM)
• A pap smear
• Laboratory examinations for the purpose of detecting fetal abnormalities
• Family planning services provided as a separate service
• Uterine ultrasound to confirm pregnancy
• RhD drugs
• Drugs used in conjunction with pregnancy, or post-pregnancy state

This list is not all-inclusive.


Billing
Abortion Related Services
Providers must:

• Fax a Medical Necessity Statement (DHS-2327) with all induced abortion claims, following the Electronic Claim Attachments instructions
• Check only one option on the form
• Bill physician service using the 837P
• Bill facility services using the 837I
• Bill all induced abortion and abortion related services for women on a fee-for-service (FFS) program or enrolled in a Managed Care organization (MCO) to MHCP. All abortion related services are paid on an FFS basis
• Induced abortion services claims require one of the following ICD codes as the first diagnosis: 635.0 through 635.9, (excluding 5th digit = 1 diagnosis codes e.g. 635.21) or 637.0 through 637.9 (excluding 5th digit = 1 diagnosis codes e.g. 637.01)
• Secondary codes must relate to the abortion procedure. Do not include family planning, contraceptive management, or pregnancy related ICD codes or the claim will deny
• Leave EPSDT field of the 837P blank
• Bill CPT procedure code 59200 (insertion of cervical dilator) separately only when the service is provided on a day other than the day the abortion was performed
• Bill CPT procedure code 88300 (surgical pathology, gross examination) only for a pathologist
• Use HCPCS codes S0190 and S0901 for medical abortions. Only bill S0190 (mifepristone) and S0191 (misoprosotol) when used together and not within 3 weeks of a surgical abortion. These codes cannot be billed with an induced abortion CPT procedure code
• Use ICD codes 69.01, 69.51 or 75.0 for induced abortion services billed by a facility
• Bill abortion related services performed after the induced abortion to MHCP
• Bill MHCP for the treatment of incomplete legally induced abortions with diagnosis codes 635.0 – 635.9 with 5th digit = 1, or 637.0 – 637.9 with 5th digit = 1. A Medical Necessity Statement is not required for an incomplete abortion reported with these diagnosis codes. Claims must include an operative report. Fax the operative report following the Electronic Claim Attachments instructions

Non-Abortion Related Services
• Bill FFS non-abortion related services on a separate claim to MHCP. Electronic claims that include both abortion and non-abortion services will deny
• Bill the MCO for non-abortion related services provided to MCO enrollees
• MCOs must pay for non-abortion related services provided by a contracted or non-contracted provider
• Bill pregnancy related services performed prior to, on the day of, or after an induced abortion (examples: diagnostic “V” codes – V22 orV23 [pregnancy], V25 [contraceptive management], and V26 [procreative management]) to MHCP for FFS recipients; the appropriate MCO for MCO enrollees
• Bill non-induced abortion services with the correct diagnoses such as a pregnancy with fetal demise, missed abortion, spontaneous abortion, etc., Bill MHCP for FFS recipients, or the appropriate MCO for MCO enrollees

Legal References
MS 256B.0625, subd.16
Minnesota Rules 9505.0
235

42 CFR 441.200-441.208 (abortion)


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