PA Lookup

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

HPV vaccine is allowed during an annual assessment or comprehensive preventive medicine evaluation.

Gardasil 9 may be administered to male and female beneficiaries through age 45 years.

For FP Medicaid, Papillomavirus laboratory testing is available during the annual assessment, comprehensive preventive medicine evaluation, or one of the six inter-periodic visits allowed under the program.

Exclusions

If an unrelated medical condition occurs or the beneficiary has no need for family planning services, the provider must refer the beneficiary to a primary care or safety net provider. In addition, hospital emergency room or emergency department services and inpatient hospital services are not covered for FP Medicaid beneficiaries.

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

Authorization Guidelines

Authorization is required for non-participating independent labs. For all other providers, no auth is required.

Conditional Requirements

Authorization is required for non-participating independent labs. For all other providers, no auth is required.

How to Submit

If applicable, please submit your request to Trillium.

• https://provider.trilliumitransact.com/HSP/iTransact/logon/logon.aspx

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

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 only during an annual assessment, comprehensive preventive medicine evaluation, or one of the six inter-periodic visits allowed per 365 days.

For FP Medicaid beneficiaries, an annual office visit assessment to determine need for family planning services must occur before other family planning or family planning-related services are rendered, unless the beneficiary already had an annual assessment, comprehensive preventive medicine evaluation, or postpartum exam in the previous 365 days.

FP Medicaid beneficiaries are limited to one comprehensive preventive medicine evaluation or one annual assessment per 365 calendar days.

FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days in addition to the annual assessment or comprehensive preventive medicine evaluation.

Laboratory procedure claims must include the AED or AAD.

Exclusions

FP Medicaid does not cover medical conditions unrelated to family planning or family planning-related services. Family Planning Medicaid beneficiaries are only eligible for services described in the covered family planning services section, and if a beneficiary has no need for family planning services or requires unrelated medical care, the provider must refer the beneficiary to primary care or a safety net provider.

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

For FP Medicaid, Trichomonas Vaginalis screening/diagnostic testing may be performed only during an annual assessment, comprehensive preventive medicine evaluation, or one of the six allowed inter-periodic visits.

FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days; each in-person or telehealth encounter counts toward that six-visit allotment.

For MAFDN/FP Medicaid claims, the Annual Assessment Date or Comprehensive Preventive Medicine Evaluation Date must be included on claims for laboratory procedures, except pregnancy tests.

Exclusions

For FP Medicaid beneficiaries, hospital emergency room or emergency department services and inpatient hospital services are not covered. FP Medicaid also 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

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

For FP Medicaid, Trichomonas Vaginalis screening/diagnostic testing may be performed only during an annual assessment, comprehensive preventive medicine evaluation, or one of the six allowed inter-periodic visits.

FP Medicaid beneficiaries are limited to six inter-periodic visits per 365 calendar days; each in-person or telehealth encounter counts toward that six-visit allotment.

For MAFDN/FP Medicaid claims, the Annual Assessment Date or Comprehensive Preventive Medicine Evaluation Date must be included on claims for laboratory procedures, except pregnancy tests.

Exclusions

For FP Medicaid beneficiaries, hospital emergency room or emergency department services and inpatient hospital services are not covered. FP Medicaid also 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