Family Planning

Revised: January 8, 2026

· Overview

· Confidentiality

· Eligible Providers

· Eligible Members

· Covered Services

· Telehealth Services

· Noncovered Services

· Billing

· Definitions

· Legal References

Overview

This section includes Minnesota Health Care Programs (MHCP) coverage and billing policy for family planning services. Refer to the Reproductive Health/OB-GYN section in the MHCP Provider Manual for links to other related services and the Minnesota Family Planning Program (MFPP).

MHCP family planning services cover services and supplies for people of childbearing age, including minors. The following considerations apply:

· Members must be free of coercion and free to choose the method of family planning they want to use

· Providers cannot require that an unmarried minor’s parent or guardian consent to family planning services for the minor

· Family planning services have no copays

Confidentiality

Family planning services do not appear on any explanations of medical benefits (EMOBs) to the member or member’s family. Members may choose to receive notices at an address other than a home address.

Eligible Providers

The following MHCP-enrolled providers may provide some, or all, of the available family planning services and supplies:

· Certified nurse midwives

· Certified nurse practitioners

· Clinical nurse specialists

· Clinics

· Family planning agencies

· Outpatient hospital departments

· Pharmacies

· Physician assistants

· Physicians

Dispensing by Protocol – Family Planning Registered Nurse

A registered nurse (RN) in a family planning agency may dispense oral contraceptives prescribed by a licensed practitioner according to a dispensing protocol established by the agency’s medical director or under the direction of a physician. RNs may not dispense oral contraception to a member who is less than 12 years old. Follow state requirements for dispensing prescription drugs.

Refer to the MHCP Provider Manual – Home webpage and the applicable sections for information and requirements relevant to the various providers.

Free Choice of Provider

All MHCP members have free choice of family planning providers and may obtain covered family planning services from any qualified provider, including those outside of their provider network.

If a provider furnishes a family planning service to a managed care member and that provider is not part of the member’s health plan provider network, the provider must contact the health plan for payment.

Eligible Members

All Medical Assistance (MA) and MinnesotaCare members are eligible, except Emergency Medical Assistance (EMA) members, of childbearing age, including minors.

Covered Services

The following are covered services for family planning:

· Consultation, examination and medical treatment

· Contraceptive devices (for example, diaphragm, intrauterine device [IUD])

· Contraceptive injections

· Emergency contraception

· Family planning counseling

· Family planning supplies (for example, condoms, thermometers)

· Genetic counseling (refer to Physician Extenders in the Physician and Professional Services section of the MHCP Provider Manual)

· HIV blood screening and counseling (performed before and after HIV blood screening test)

· Infertility services, limited to diagnosis and treatment of medical problems causing infertility (for example, pituitary or ovarian tumor, testicular mass)

· Laboratory examination and tests, including screening for cervical cancer by Pap smear and pregnancy testing as clinically indicated

· Prescriptions for the purpose of family planning

· Testing of sexually transmitted infections (STIs)

· STI prevention techniques (vaccinations, condoms, and so on)

· Treatment of non HIV-related STIs

· Voluntary sterilization (refer to Sterilization in the MHCP Provider Manual)

Members enrolled in managed care organizations must seek treatment for HIV/AIDS or infertility treatment through their managed care network.

Refer to the HIV/AIDS Web Resources webpage for information about treatment for fee-for-service members.

Not all covered family planning services are directly provided by family planning providers. Members must be fully informed of, and freely consent to, all family planning services.

Telehealth Services

Telehealth services are covered for MHCP members. Providers must submit a completed and signed Telehealth Provider Assurance Statement (DHS-6806) (PDF) to the Minnesota Department of Human Services to bill for telehealth services. Review Telehealth Services in the MHCP Provider Manual for more information.

Noncovered Services

MHCP does not cover the following services:

· Artificial insemination

· In vitro fertilization

· Fertility drugs and all associated services

· Reversal of voluntary sterilization

Billing

Refer to the following when billing for family planning services:

· Bill using the MN–ITS 837P

· Pharmacies: Bill point of sale (POS) for drugs; use the 837P for Equipment and Supplies

· If you provide oral contraceptive products and emergency contraceptives on the same date of service, list them on separate claim lines.

· For genetic counseling, refer to the special billing instructions in the Physician Extenders portion of the Physician and Professional Services section of the MHCP Provider Manual

· Long-acting reversible contraceptives can be billed outside of a hospital bundle for labor and delivery. Follow outpatient billing procedure when submitting claims.

· If billing CPT Code 58301 for members with Medicare insurance, include diagnosis code Z31.69 when the long-acting reversible contraceptive is for contraception and not another medical need.

Definitions

Family Planning Service
A family planning service includes screening, testing and counseling for sexually transmitted diseases, such as HIV, when provided in conjunction with the voluntary planning of conception and childbearing, and related to a member’s condition of fertility.

Family Planning Supply
A family planning supply is a prescribed drug or contraceptive device ordered by a physician or other eligible provider with prescribing authority for treatment of a condition related to a family planning service.

Family Planning Agency
A family planning agency is an entity having a medical director that provides family planning services under the direction of an MHCP-enrolled physician. The medical director must ensure that trained personnel perform the counseling and provide information about family planning according to accepted community standards.

Legal References

Minnesota Session Laws 2007
Minnesota Statutes, 256B.0625, subdivision 13, Covered Services (Drugs)
Minnesota Statutes, 151.212, subdivision 1, Label of Prescription Drug Containers (Prescription drugs)
Minnesota Rules, 9505.0280, Family planning services