Update to Reimbursement of Long Acting Reversible Contraceptives (LARCs)

Effective for dates of service on or after Oct. 1, 2018, the following DRG classifications specific to LARCs will be added to the current Grouper 36 version within NCTracks for claims reimbursement.

A copy of the DRG Grouper Version 36 weights and thresholds in Excel format will be posted to the Hospital Fee Schedule web page under "Grouper 36 DRG Weight Table" on the NC Medicaid website.

The NC Medicaid covers the insertion/implanting of Long Acting Reversible Contraceptives (LARCs) under Clinical Policy 1E – 7 Family Planning Services.

New LARC DRGs

Effective Oct. 1, 2018, new LARC diagnosis and procedure codes will be implemented to DRG Version 36 of the Medicare Grouper for reimbursement of claims. The new DRG codes listed will allow hospitals and physicians to receive additional fees for LARC insertion. In addition, the new policy allows hospitals to receive reimbursement for the cost of five LARC devices listed.

Inpatient Hospital Services

The payment of LARCs is included in the DRG payment of the delivery. Since this is a covered service, the cost of the LARC is an allowable cost on the cost report, which is used in the calculation of the MRI/GAP supplemental payments.

Billing Notes

To receive appropriate reimbursement for LARCs within an inpatient setting, please review the following. All codes listed below must be included on LARC claims as indicated.

To document LARC services provided after the delivery, hospital providers must use one of the new DRGs listed below.

Hospital LARC claims should be billed using the following ICD-10-PCS codes:

Hospital LARC claims should be billed using the following Healthcare Common Procedure Coding System (HCPCS) codes:

Outpatient Hospital Services

If the LARC is inserted/implanted during an outpatient encounter, the LARC is billed on the claim, along with the appropriate HCPCS and NDC codes. If the LARC is billed under 340B pricing, the UD modifier must be used. OMA will reimburse the hospital claim at 70% of cost. Similar to inpatient services, the cost is allowable and will be considered in the calculation of the MRI/GAP supplemental payments.