Apple Health - Billing for contraceptive implant procedure

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Apple Health (Medicaid): Provider Alert

Effective for dates of service on and after July 1, 2017, use modifier FP with procedure codes 11981, 11982, and 11983 when billing for contraceptive subdermal implant procedures.

This modifier is used by the Health Care Authority to distinguish contraceptive drug delivery systems from other drug delivery systems.  

Providers are eligible to receive the enhanced reimbursement rate authorized in WAC 182-531-2020 when using procedure code 11981 or 11983 to bill for the insertion of a contraceptive drug delivery system. Providers must use the FP modifier to receive this enhanced rate.

Noncontraceptive drug delivery systems do not qualify the provider for the enhanced rate and the modifier FP should not be used.

Use of the FP modifier for these procedures codes is described in the July 1 publication of the Family Planning Billing Guide.