Payment Proposed for Inpatient Long-acting Reversible Contraception Devices

Posted on May 30, 2018

The Medical Services Administration (MSA) recently released a proposed policy to establish Medicaid payment for long-acting reversible contraception (LARC) implants and intrauterine devices provided in the inpatient hospital setting following the delivery of a baby.

Effective for dates of service on or after Oct. 1, 2018, the MSA proposes to pay hospitals for LARC devices when the device is provided to an obstetrical patient postpartum and prior to discharge. This payment is in addition to the diagnosis-related group payment to the hospital for the obstetrical services. Under existing Medicaid policy, the LARC is payable only when performed in the outpatient setting after delivery. Advocacy efforts by the MHA and its members resulted in the proposed change to provide Medicaid payment for these services when performed at the time of delivery.

To receive the additional LARC payment, the hospital must submit a separate professional claim denoting “place of service 21 – Inpatient Hospital.” The professional claim would include the hospital as the billing provider and list the practitioner performing the procedure as the rendering provider. The hospital must use the appropriate Healthcare Common Procedure Coding System Level II procedure code and National Drug Code. Facilities participating in the federal 340B drug pricing program are required to continue to bill the 340B actual acquisition cost for LARC devices.

Hospitals are encouraged to review the proposed policy and submit comments to the MSA by June 21. Members with questions should contact Vickie Kunz at the MHA.

Tags: MSA, Obstetrics, OB

Posted in: Member News

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