Information for Dates of Service Before October 1, 2015

Diagnosis Codes

The following are allowable contraceptive management diagnosis codes for Family Planning Only Services:

V25 — Encounter for contraceptive management

V25.0 —	General counseling and advice
	V25.01 — Prescription of oral contraceptives V25.02 — Initiation of other contraceptive measures Fitting of diaphragm Prescription of foams, creams, or other agents V25.09 — Other Family planning advice
V25.1 —	Insertion of intrauterine contraceptive device
V25.2 —	Sterilization Admission of interruption of fallopian tubes
V25.3 —	Menstrual extraction Menstrual regulation
V25.4 —	Surveillance of previously prescribed contraceptive methods Checking, reinsertion, or removal of contraceptive device Repeat prescription for contraceptive method Routine examination in connection with contraceptive maintenance
	V25.40 — Contraceptive surveillance, unspecified V25.41 — Contraceptive pill V25.42 — Intrauterine contraceptive device Checking, reinsertion, or removal of intrauterine device V25.43 — Implantable subdermal contraceptive V25.49 — Other contraceptive method
V25.5 —	Insertion of implantable subdermal contraceptive
V25.9 —	Unspecified contraceptive management

Claims submitted for members enrolled in Family Planning Only Services must include either an ICD-9-CM diagnosis code in the V25 range if the service provided was related to contraceptive management or modifier "FP" if the service provided was related to family planning and a diagnosis code in the V25 range is not appropriate. For certain procedures and services, the V25 diagnosis code must be included as the primary diagnosis or the detail must include modifier "FP." Claims for members enrolled in Family Planning Only Services that are submitted without either a V25 diagnosis code or modifier "FP" on the detail level of the claim will be denied.