Clarification on Billing for Long Acting Reversible Contraceptives (LARCs)

Thursday, January 24, 2019

For clarification purposes of information communicated in October 2018 Medicaid Bulletin, please note that effective Oct. 1, 2018 the new 4-digit Long Acting Reversible Contraceptives (LARC) DRG code is not required to be submitted on the claim.

For Inpatient Hospital services the appropriate reimbursement process will begin after the claim has been grouped using the Grouper Software as usual. Either the original maternity DRG, or the LARC will be assigned systematically.

If the LARC is inserted/implanted during an inpatient stay, and the provider seeks to receive the appropriate LARC reimbursement, the following ICD-10 and HCPCS codes should be billed on the claim accordingly.

ICD-10-PCS codes:

  • OU.H97HZ Insertion of Contraceptive Device into Uterus, via Opening
  • OU.H98HZ Insertion of Contraceptive Device into Uterus, Endo
  • OU.HC8HZ Insertion of Contraceptive Device into Cervix, Endo
  • OU.HC7HZ Insertion of Contraceptive Device into Cervix, via Opening
  • OU.H90HZ Insertion of Contraceptive Device into Uterus, Open Approach

HCPCS codes:

HCPCS Device

J7297

 Liletta®
J7298 Mirena ®
J7300 Paragard®
J7301 Skyla®
J7307 Nexplanon ®

Once Inpatient hospital LARC services are billed accordingly, the system will automatically assign the appropriate LARC DRG code listed below:

1765 Cesarean Section W CC/MCC with LARC
1766 Cesarean Section W/O CC/MCC with LARC
1767 Vaginal Delivery W Sterilization &/or D&C with LARC
1768 Vaginal Delivery W O.R. Proc Except Sterile &/or D&C with LARC
1769 Postpartum & Post Abortion Diagnoses W O.R. Procedure with LARC
1770 Abortion W D&C, Aspiration Curettage or Hysterectomy with LARC
1774 Vaginal Delivery W Complicating Diagnoses with LARC
1775 Vaginal Delivery W/O Complicating Diagnoses with LARC
1776 Postpartum & Post Abortion Diagnoses W/O O.R. Procedure with LARC
1777 Ectopic Pregnancy with LARC
1779 Abortion W/O D&C with LARC

Author: 
Provider Reimbursement, 919-814-0060