Author: GDIT Call Center, 1-800-688-6696
Clinical Policy 1E-7, Family Planning Services, has been revised and posted on the NC Medicaid website.
1. Ultrasounds:
a. MAFDN eligible beneficiaries:
Effective Nov. 1, 2018, during the annual exam or interperiodic visit, if the intrauterine contraceptive device (IUD) is malpositioned or the string is missing, providers may check IUD placement by performing an ultrasound. Health record documentation supporting that the ultrasound was performed due to malposition or a missing string must be submitted with the claim. If it is determined that additional medical care is necessary due to an IUD complication, the provider must refer the MAFDN eligible beneficiary to the local department of social services, health department, federally qualified health center (community health center) or rural health clinic in their county. If one of the above primary care providers is not available in the county where the beneficiary resides, the beneficiary may seek services in nearby or surrounding counties.
Prior authorization (PA) will not be required for the following ultrasound codes if the beneficiary has MAFDN eligibility.
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76830 – ultrasound, transvaginal
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76856- ultrasound, pelvic (nonobstetric), real time with image documentation;
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76857- ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (e.g., for follicles)
b. Traditional Medicaid beneficiaries
Providers should refer to Clinical Policy 1K-7 Prior Approval for Imaging Services for guidance related to ultrasounds for traditional Medicaid beneficiaries. Health record documentation is not necessary with claim submissions.
2. Effective Nov. 1, 2018, bacterial vaginosis (BV) testing and treatment will be covered for beneficiaries with MAFDN eligibility. The following CPT codes, diagnoses and medications have been added to Clinical Policy 1E-7, Family Planning Services:
CPT codes
- 87480 – Candida species, direct probe technique
- 87510 – Gardnerella vaginalis, direct probe technique
- 87660 – Trichomonas vaginalis, amplified probe technique
Diagnosis codes
- N76.0 – acute vaginitis
- N76.1 – subacute and chronic vaginitis
- N76.2 – acute vulvitis
- N76.3 – subacute and chronic vulvitis
Medications
- Metronidazole 250mg, 500mg
- Metronidazole gel 0.75%
- Clindamycin cream 2%
- Clindamycin oral 150mg
- 300mg, Clindamycin ovules100mg
- Tinidazole 2gm, 1 gm, 500mg, 250mg
3. The medication list has been updated in Clinical Policy 1E-7, Family Planning Services. Effective Nov. 1, 2018, Gentamycin 240mg IM has been added for the treatment of gonorrhea.
4. Effective Nov. 1, 2018, CPT code 36415 (Collection of venous blood by venipuncture) has been added to Clinical Policy 1E-7, Family Planning Services. Providers billing for a venipuncture for a MAFDN beneficiary should follow guidelines in Clinical Policy 1S-3, Laboratory Services. Only one venipuncture specimen collection is reimbursable to the provider who extracted the specimen, when the specimen is sent to an independent laboratory for testing and no testing is done in the office.
5. The list of safety net providers has been removed from Clinical Policy 1E-7, Family Planning Services.
6. If a medical condition unrelated to family planning or family planning-related services occurs, or the beneficiary has no need for family planning services, the provider shall refer the beneficiary to the local department of social services, health department, federally qualified health center (community health center) or rural health clinic in their county. If one of the above primary care providers is not available in the county where the beneficiary resides, the beneficiary may seek services in nearby or surrounding counties.
Long-Acting Reversible Contraception: Intrauterine Device
Effective Nov. 1, 2018, when it has been confirmed that an intrauterine device (IUD) has been expelled, providers may reinsert a replacement IUD without any waiting period.