February 2018

Update to the TMPPM Gynecological, Obstetrics and Family Planning Handbook for LARC/LARC Devices

Note: Texas Medicaid managed care organizations (MCO) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures, such as prior authorization, pre-certification, referrals and claims/encounter data filing, may differ from traditional Medicaid (fee-for-service), and from MCO to MCO. Providers should contact the client's specific MCO for details.

As of Feb. 1, 2018, the Texas Medicaid Provider Procedures Manual’s (TMPPM) Gynecological, Obstetrics and Family Planning Handbook have been updated to include language that specifically refers to intrauterine devices (IUD) and implantable capsules as long-acting reversible contraceptives (LARC).

The following subsections have been updated to include this terminology:

2.2.5: Contraceptive Devices and Related Procedures
2.2.6: Drugs and Supplies

Reminder: Procedure codes for LARCs may be reimbursed in addition to the hospital diagnosis-related group (DRG) payment when insertion is performed immediately postpartum.

Language in subsection 2.2.5.4: Immediate Postpartum Insertion of IUDs and Implantable Contraceptive Capsules has also been updated regarding immediate postpartum LARC insertion and claims processing procedures, as follows:

Procedure codes for LARCs may be reimbursed in addition to the hospital DRG payment when insertion is performed immediately postpartum. “Immediately postpartum” refers to the following:

Insertion within 10 - 15 minutes of placental delivery for intrauterine IUD
Insertion prior to discharge for implantable contraceptive capsules

For claims submitted to the Texas Medicaid and Healthcare Partnership (TMHP) for processing, hospital and facility providers must submit an outpatient claim with the appropriate procedure code for the contraceptive device. This is in addition to the inpatient claim for the delivery services.
For claims submitted to a Texas Medicaid MCO, providers must follow the MCO’s claim processing procedures for reimbursement of immediate postpartum LARC devices. This is in addition to the rate for delivery services.

Important: Medicaid MCOs must adopt claim processing procedures to reimburse hospital and facility providers for immediate postpartum LARC devices in addition to the rate for delivery services.

For more information, call the TMHP Contact Center at 1-800-925-9126.