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Family Planning Codes with Increased Rates

Revised: 07-18-2016

When a recipient’s primary ICD diagnosis is in the V25.0 – V25.9 range for ICD-9 diagnosis prior to October 1, 2015, and Z30.011 – Z30.9 for ICD-10 diagnosis on and after October 1, 2015, MHCP-covered family planning procedure codes in the table below receive the following legislative rate increases:

  • • 25% increase, effective July 2, 2007
  • • Additional 20% increase, effective July 1, 2013
  • Note: Codes added as of July 1, 2013, are denoted by the date.

    Code

    Description

    00840

    Anesth, surg low abdmn

    00851

    Anesth, tubal lig/transect

    00920

    Anesth, genitalia surgery

    00921

    Anesth, vasectomy

    00952

    Anesth, uterine endo

    11976

    Remove of contracep cap

    11981

    Insert drug implant device

    11982

    Remove drug implant device

    49320

    Diag laparo sep proc (7/1/13)

    49321

    Laparoscopy, biop (7/1/13)

    49329

    Lap proc, abdm/per/omentum (7/1/13)

    52010

    Cystoscopy & duct cath (7/1/13)

    54500

    Biop testis, needle (7/1/13)

    54505

    Biop testis, incis (7/1/13)

    54830

    Excise epididymis lesion (7/1/13)

    54865

    Explore epididymis (7/1/13)

    54900

    Fuse sperm ducts, unilatl (7/1/13)

    54901

    Fuse sperm ducts, bilat (7/1/13)

    55200

    Vas cannul w/wo incis (7/1/13)

    55250

    Vas, uni/bilat postop semen exam

    55300

    Prep for sperm duct x-ray (7/1/13)

    55450

    Ligate sperm duct (7/1/13)

    55520

    Excis sperm cord les (7/1/13)

    55530

    Revise sperm cord veins (7/1/13)

    55535

    Revise sperm cord veins abd (7/1/13)

    55540

    Excis hernia & sperm veins (7/1/13)

    55600

    Vesiculotomy (7/1/13)

    55605

    Vesiculotomy; complicated (7/1/13)

    55680

    Excis Mullerian duct cyst (7/1/13)

    55870

    Electroejaculation (7/1/13)

    57150

    Vag irrigate/med app tx (7/1/13)

    57170

    Fit diaphragm/cap (7/1/13)

    57410

    Pelvic exam under anesth

    57505

    Endocervical curettage (7/1/13)

    57700

    Revision of cervix (7/1/13)

    57720

    plastic repair cervix (7/1/13)

    57800

    Dilation of cervical canal (7/1/13)

    58100

    Biopsy uterus lining (7/1/13)

    58120

    Dilation & curettage (7/1/13)

    58140

    Myomectomy abd approach (7/1/13)

    58145

    Myomectomy vag approach (7/1/13)

    58300

    Insertion IUD

    58301

    Remove IUD

    58340

    Inject for ut/tube x-ray

    58345

    Reopen fallopian tube (7/1/13)

    58350

    Chromotubation oviduct (7/1/13)

    58400

    Uterine suspension (7/1/13)

    58540

    Hyseroplasty, (Strassman) (7/1/13)

    58555

    Hysteroscopy, diagnostic (7/1/13)

    58558

    Hysteroscopy, biopsy (7/1/13)

    58559

    Hysteroscopy, lysis (7/1/13)

    58560

    Hysteroscopy resect septum (7/1/13)

    58561

    Hysteroscopy remove myoma (7/1/13)

    58565

    Hysteroscopy bi tube cannul

    58600

    Ligate/transect tubal, ab/vag

    58605

    Lig/tran tubpostpart same stay (7/1/13)

    58611

    Ligation oviduct(s) (7/1/13)

    58615

    Fal tube occlusion w device

    58660

    Laparoscopy lysis (7/1/13)

    58670

    Lap w fulg ovid w/wo transect

    58671

    Lap w occlus ovid by device

    58672

    Laparoscopy fimbrioplasty (7/1/13)

    58673

    Laparoscopy salpingostomy (7/1/13)

    58700

    Salpingectomy (7/1/13)

    58740

    Lysis of adhesions (7/1/13)

    58752

    Revise ovarian tube(s) (7/1/13)

    58760

    Fimbrioplasty (7/1/13)

    58770

    Salpingostomy (7/1/13)

    58825

    Transposition, ovary(s) (7/1/13)

    58900

    Biopsy of ovary (7/1/13)

    58920

    Wedge resec/bisect ovar (7/1/13)

    74000

    Rad exam, abd 1 anteropost

    74740

    Hysterosalpingography (7/1/13)

    74742

    X-ray fallopian tube (7/1/13)

    76856

    Echography pelvic complete

    76857

    Echography pelvic (7/1/13)

    76870

    Echography scrotum (7/1/13)

    76872

    Ultrasound transrectal (7/1/13)

    76948

    Echo guide ova aspiration (7/1/13)

    77080

    DXA axial

    77081

    DXA appendicular

    93975

    Vascular study (7/1/13)

    93976

    Dup scn flw art in&ven out (7/1/13)

    96372

    Ther/proph/diag inj, sc/im (7/1/13)

    99078

    Grp health ed

    99201

    Office/outpt visit–new pt

    99202

    Office/outpt visit–new pt

    99203

    Office/outpt visit–new pt

    99204

    Office/outpt visit–new pt

    99205

    Office/outpt visit–new pt

    99211

    Office/outpt visit–new pt

    99212

    Office/outpt visit–est pt

    99213

    Office/outpt visit–est pt

    99214

    Office/outpt visit–est pt

    99215

    Office/outpt visit–est pt

    99241

    Office consultation (7/1/13)

    99242

    Office consultation (7/1/13)

    99243

    Office consultation (7/1/13)

    99244

    Office consultation (7/1/13)

    99245

    Office consultation (7/1/13)

    99384

    Prevent visit new 12-17

    99385

    Prevent visit new 18–39

    99386

    Prevent visit new 40–64

    99394

    Prevent visit est 12-17

    99395

    Prevent visit est 18–39

    99396

    Prevent visit est 40–64

    99401

    Prev counsel indv 15 min

    99402

    Prev counsel indv 30 min

    99403

    Prev counsel indv 45 min

    99404

    Prev counsel indv 60 min

    99411

    Prev counsel grp 30 min

    99412

    Prev counsel grp 60 min

    A4261

    Cerv cap contracep

    A4266

    Diaphragm

    A4267

    Male condom

    A4268

    Female condom

    A4269

    Spermicide

    G0433

    Elisa HIV-1/HIV-2 screen

    H1010

    Nonmed fam plan ed

    J0561

    Inj pen G benz to 2.4 mil (7/1/13)

    *J0696

    Inj ceftriaxone sodium (7/1/13)

    J1050

    Medroxyprog acet 1 mg inj

    J7297

    Levongestrel IUD (52 mg 3 yr)

    J7298

    Levongestrel IUD (52 mg 5 yr)

    J7300

    copper IUD

    J7301

    Levongestrel IUD (13.5 mg)

    *J7302

    Levonorgestrel IUD system

    *J7303

    Contracept vaginal ring

    *J7304

    Contracept patch

    J7307

    Etonogestrel impl system

    *J8499

    Prescription drug, oral, NOS, non-hormonal OC/EC: Use to report CDC recommended drugs for treatment of STIs when dispensed in the office, for example Amoxicillin, Cefixime, Ciprofloxacin, Clindamycin, Clotrimazole, Doxycycline, Fluconazole, Metronidazole, Nitrofurantoin, Ofloxacin, Sulfa-methoxazole/Trimethoprim, Terconazole.

    Q0090

    Levonorgestrel IUD system (13.5 mg)

    Q0091

    Pap smear (7/1/13)

    *S4989

    Contracept IUD

    *S4993

    Contracept BC pills (hormonal)

    T1013

    Oral language interp (7/1/13)

    *Indicates the HCPCS code requires an NDC, dispensing unit, and quantity when billing MHCP. Refer to HCPCS Codes Requiring NDC.

    MHCP Provider Call Center 651-431-2700 or 800-366-5411; TDD: 7-1-1
    http://www.dhs.state.mn.us/provider

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