Author: GDIT, 1-800-688-6696
The following CPT codes should not be billed with a separate office visit. An office visit component is included in reimbursement for these CPT codes.
- 11981 – insertion, non-biodegradable drug delivery implant
- 11982 – removal, non-biodegradable drug delivery implant
- 11983 – removal with reinsertion, non-biodegradable drug delivery implant
- 57170 – diaphragm or cervical cap fitting with instructions
- 58300 – insertion of intrauterine device (IUD)
- 58301 – removal of intrauterine device (IUD)
If during an annual exam, the beneficiary requests an IUD insertion or an IUD removal or during the annual visit the beneficiary decides to switch from birth control pills to an IUD, the provider may bill for the annual exam and the IUD insertion or IUD removal. An appropriate modifier must be submitted with the annual exam procedure code, indicating that the service rendered was a separately identifiable service provided by the same provider on the same day of service. The providers documentation must support that the service rendered was a separately identifiable service provided by the same provider on the same day of service.
If the only reason that the beneficiary is seen in the office is to request an IUD insertion, an IUD removal, insertion of a non-biodegradable drug delivery implant, removal of a non-biodegradable drug delivery implant, removal with reinsertion of a non-biodegradable drug delivery implant, or diaphragm or cervical cap fitting with instructions providers shall not bill a separate office visit. An office visit component is contained in the reimbursement for CPT procedure codes 58300, 58301, 57170, 11981, 11982 and 11983. However, if during the same visit, services are rendered for a separately identifiable service provided by the same provider on the same day of service, the provider may bill for the office visit and the IUD insertion or IUD removal. The providers documentation must support that the service rendered was a separately identifiable service.