PA Lookup

How to Submit

N/A - No authorization is required

Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.

Limits

Family Planning Medicaid allows STI screenings during the annual assessment, comprehensive preventive medicine evaluation, or the six inter-periodic visits.

Pregnancy tests, sexually transmitted infection screening, and HIV screening can be performed during an annual assessment, comprehensive preventive medicine evaluation, or any of the six inter-periodic visits allowed under the program.

For FP Medicaid beneficiaries, the annual assessment or comprehensive preventive medicine evaluation is generally required before other family planning or family planning-related services are rendered; if one has been completed within the previous 365 days, another is not required before receiving services.

Exclusions

For FP Medicaid beneficiaries, medical conditions unrelated to family planning or family planning-related services are not covered, and treatment for acute or chronic conditions discovered during screening is not covered. Medical treatment for HIV, Hepatitis B, and Hepatitis C is also not covered by Family Planning Medicaid.

Place of Service

Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.

Additional Service Specifics

FP, QW. GT applies only when the service is telehealth billable and delivered by interactive audio-video.

How to Submit

N/A - No authorization is required

Resources

• 1E-7 Family Planning Services
• Records Management and Documentation Manual

Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.

Limits

Treponema testing is allowed during an annual assessment, comprehensive preventive medicine evaluation, or any of the six inter-periodic visits allowed under FP Medicaid.

For FP Medicaid, laboratory procedures generally require the Annual Assessment Date or Annual Evaluation Date on the claim.

Exclusions

Treponema testing is not separately excluded by name in the policy. However, FP Medicaid does not cover medical conditions unrelated to family planning or family planning-related services, and treatment for acute or chronic conditions discovered during screening is not covered under FP Medicaid.

Place of Service

Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.

Additional Service Specifics

FP, QW. GT applies only when the service is telehealth billable and delivered by interactive audio-video.

How to Submit

N/A - No authorization is required

Resources

• 1E-7 Family Planning Services
• Records Management and Documentation Manual

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.

Limits

Covered for FP Medicaid during either the annual assessment, a comprehensive preventive medicine evaluation, or one of the six inter-periodic visits allowed under the FP Medicaid program.

HIV, Hepatitis B, Hepatitis C, and other STI screenings may be performed only after an annual assessment or comprehensive preventive medicine evaluation has been performed.

Each in-person or telehealth inter-periodic encounter counts toward the beneficiary's limit of six inter-periodic visits per 365 calendar days.

Claims for laboratory procedures must include the Annual Evaluation Date or Annual Assessment Date.

Exclusions

Medical treatment for Hepatitis C is not covered by Family Planning Medicaid; only screening is covered.

Place of Service

Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.

Additional Service Specifics

FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.

How to Submit

N/A - No authorization is required

Resources

• 1E-7 Family Planning Services
• Records Management and Documentation Manual

Family Planning Medicaid services are provided to an eligible Medicaid beneficiary of childbearing age to temporarily or permanently prevent or delay pregnancy. Medicaid Family Planning is designed to reduce unintended pregnancies and improve the well-being of children and families in North Carolina.

Limits

Covered for FP Medicaid during either the annual assessment, a comprehensive preventive medicine evaluation, or one of the six inter-periodic visits allowed under the FP Medicaid program.

HIV, Hepatitis B, Hepatitis C, and other STI screenings may be performed only after an annual assessment or comprehensive preventive medicine evaluation has been performed.

Each in-person or telehealth inter-periodic encounter counts toward the beneficiary's limit of six inter-periodic visits per 365 calendar days.

Claims for laboratory procedures must include the Annual Evaluation Date or Annual Assessment Date.

Exclusions

Medical treatment for Hepatitis C is not covered by Family Planning Medicaid; only screening is covered.

Place of Service

Non-Telehealth Claims: a. Inpatient hospitals (not applicable for a FP Medicaid beneficiary) b. Outpatient hospital: For a FP Medicaid beneficiary, the only surgical procedure or service allowed requiring outpatient beneficiary registration is sterilization, IUD removal or ultrasound for IUD related complications including missing strings. c. Office: utilizing offices within places of service 11 (Office), 19 (Off Campus Outpatient) or 22 (On Campus Outpatient) d. Ambulatory Surgical Centers (applicable for a FP Medicaid beneficiary for a sterilization. Numeric POS code(s): 02-Telehealth Provided Other than in Patient's Home.

Additional Service Specifics

FP. GT applies only when the service is telehealth billable and delivered by interactive audio-video.

How to Submit

N/A - No authorization is required

Resources

• 1E-7 Family Planning Services
• Records Management and Documentation Manual

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required

How to Submit

N/A - No authorization is required