Contraceptives are covered for members who are 10 through 65 years of age.
HCPCS procedure codes and descriptions for age-restricted contraceptives are in the table below. Procedure codes for Medicaid-covered contraceptives are listed in the maximum allowable fee schedule.
| Age-Restricted Contraceptives | |
|---|---|
| Procedure Code | Description |
| J7297 | Levonorgestrel-releasing intrauterine contraceptive system (lilleta), 52 mg |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg |
| J7300 | Intrauterine copper contraceptive |
| J7301 | Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg |
| J7303 | Contraceptive supply, hormone containing vaginal ring, each |
| J7304 | Contraceptive supply, hormone containing patch, each |
| J7306 | Levonorgestrel (contraceptive) implant system, including implants and supplies |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies |
| S4993 | Contraceptive pills for birth control |
| S4993-U1 | Contraceptive pills for birth control—emergency contraception |