Covered family planning services are identified by the allowable CPT and HCPCS procedures codes listed in the following tables.
Evaluation and Management Services |
Procedure Codes |
|---|---|
Office or Other Outpatient Services |
99201-99215 |
Preventive Medicine Services |
99384-99387, 99394-99397 |
Medicine Services |
Procedure Codes |
|---|---|
Immune Globulins |
90384-90386 |
Cardiovascular |
93000, 93010 |
| Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | 96372 |
Special Services, Procedures and Reports |
99000 |
Surgery Services |
Procedure Codes |
|---|---|
Contraceptive implants |
11976, 11981-11983 |
Male Genital System |
54050, 55250*, 55450* |
Female Genital System |
56440, 56501, 56605, 56606, 57061, 57170, 57452, 57454-57461, 57500, 58100-58120, 58300-58301, 58565*, 58600*, 58605*, 58615*, 59000, 59840-59851** |
Anesthesia Services |
Procedure Codes |
|---|---|
Lower Abdomen |
00851 |
Perineum |
00921, 00952 |
Radiology Services |
Procedure Codes |
|---|---|
Chest |
71010-71022, 71030-71035 |
Spine and pelvis |
72170, 72190, 72200, 72202 |
Abdomen |
74000-74020 |
Gynecological and obstetrical |
74710 |
Abdomen and peritoneum |
76705 |
Pelvis |
76805, 76815, 76856 |
Extremities |
76885-76886 |
Ultrasonic guidance procedures |
76946, 76970 |
Laboratory Services |
Procedure Codes |
|---|---|
Organ or Disease Oriented Panels |
80050, 80055-80061, 80081 |
Urinalysis |
81000, 81002, 81005, 81015, 81025 |
Chemistry |
82042, 82143, 82310, 82330, 82435, 82465, 82520, 82565, 82575, 82607, 82671-82677, 82728, 82746, 82947-82948, 83020, 83030-83033, 83045, 83518, 83540-83550, 83582-83593, 83655, 83718-83719, 83727, 83840, 83887-83889, 84132, 84135, 84144-84146, 84295, 84315, 84403-84425, 84436-84445, 84478-84481, 84702-84703 |
Hematology and Coagulation |
85002-85007, 85009-85018, 85027-85041, 85060, 85651, 85660 |
Immunology |
86280, 86310, 86580, 86592-86593, 86631, 86689, 86694-86695, 86701, 86703, 86706, 86762-86765, 86787, 86800 |
Transfusion Medicine |
86850, 86900-86901 |
Microbiology |
87040, 87070, 87081, 87086, 87088, 87101, 87102, 87118, 87205, 87210, 87270, 87274, 87320, 87340, 87350, 87380, 87390-87391, 87449, 87485-87492, 87510-87517, 87528, 87530-87539, 87590-87591, 87623-87652, 87798-87799 |
Cytopathology |
88141-88152, 88155-88161 |
Cytogenetic Studies |
88261-88267, 88280 |
Other Procedures |
89300-89320 |
| Education Services | Procedure Code |
|---|---|
| Non-medical family planning education, per session | H1010* |
* Providers may not bill procedure code H1010 with a preventive medicine visit since family planning education is included in a preventive medicine visit.
Supplies and Drugs |
Procedure Codes |
|
|---|---|---|
Cervical cap for contraceptive use |
A4261 |
Permanent implantable contraceptive intratubal occlusion device(s) and delivery system |
A4264 |
Diaphragm for contraceptive use |
A4266 |
|
Contraceptive supply, condom, male, each |
A4267 |
|
Contraceptive supply, condom, female, each |
A4268 |
|
Contraceptive supply, spermicide (e.g., foam, gel), each |
A4269 |
|
Injection, penicillin G benzathine, 100,000 units |
J0561 |
|
Injection, ceftriaxone sodium, per 250 mg |
J0696 |
|
Injection, medroxyprogesterone acetate, 1 mg |
J1050 |
|
Unclassified drugs |
J3490 |
|
Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52mg |
J7297 |
|
Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52mg |
J7298 |
|
Intrauterine copper contraceptive |
J7300 |
|
Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg |
J7301 |
|
Contraceptive supply, hormone containing vaginal ring, each |
J7303 |
|
Contraceptive supply, hormone containing patch, each |
J7304 |
|
Etonogestrel (contraceptive) implant system, including implant and supplies |
J7307 |
|
Prescription drug, oral, non chemotherapeutic, NOS |
J8499 |
|
Levonorgestrel-releasing intrauterine contraceptive system [Kyleena], 19.5 mg |
Q9984*** |
|
Mifepristone, oral, 200 mg |
S0190**** |
|
Misoprostol, oral, 200 mcg |
S0191**** |
|
Contraceptive pills for birth control |
S4993 |
|
Contraceptive pills for birth control — emergency contraception |
S4993-GD |
|
Azithromycin dehydrate, oral, capsules/powder, 1 gm |
Q0144 |
|
Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided) |
99070 |
|
* This services requires completion of the Consent for Sterilization form.
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