This bulletin is applicable to both NC Medicaid Managed Care and NC Medicaid Direct.
NC Medicaid is updating Coverage Policy 1E-7, Family Planning Services, effective May 1, 2025. Key changes include:
- Depression Screenings: The addition of four depression screenings can be administered during Family Planning visits.
- Hysteroscopy Coverage: Coverage is expanded to include hysteroscopy in outpatient hospital settings for Intrauterine Device (IUD) removal due to complications.
- Ultrasound Services: Added Outpatient Place of Service for ultrasounds for IUD removal or related complications
- HPV Testing: Added CPT code 87626 for self-collection of specimens for Human Papillomavirus (HPV) testing
- Pharmacy Protocols: Added State protocols for pharmacies. Oral Contraceptives and Transdermal Patches may be dispensed per the NC State Health Director’s Standing Order (includes OPILL).
- Telehealth: New patient visits may now be conducted via telehealth
- Syphilis Testing: Coverage for Point-of-Care syphilis testing
- HPV Vaccine: Coverage of administration of the HPV vaccine per the Advisory Committee on Immunization Practice guidelines at any Family Planning visit.
Providers are encouraged to review the full Clinical Coverage Policy 1E-7, Family Planning Services for a detailed overview of other general language and formatting updates to the policy.
For more information on related updates, providers can refer to bulletin Medicaid to Cover Condoms and Spermicides Over-the Counter.
Contact
NC Medicaid Contact Center, 888-245-0179