1. (1) Family planning services are those intended to prevent or delay pregnancy, or otherwise control family size.
2. (2) The Division of Medical Assistance Programs (Division) covers family planning services for clients of childbearing age (including minors who are considered to be sexually active).

3. (3) Family Planning services include:

   1. (a) Annual exams;
   2. (b) Contraceptive education and counseling to address reproductive health issues;
   3. (c) Laboratory tests;
   4. (d) Radiology services;
   5. (e) Medical and surgical procedures, including tubal ligations and vasectomies;
   6. (f) Pharmaceutical supplies and devices.

4. (4) Clients may seek family planning services from any provider enrolled with the Division, even if the client is enrolled in a Prepaid Health Plan (PHP). Reimbursement for family planning services is made either by the client’s PHP or the Division. If the provider is:

   1. (a) A participating provider with the client’s PHP, bill the PHP;
   2. (b) An enrolled Division provider, but is not a participating provider with the client’s PHP, bill the Division and add modifier –FP to the billed code.
5. (5) Family planning methods include natural family planning, abstinence, intrauterine device, cervical cap, prescriptions, sub-dermal implants, condoms, and diaphragms.
6. (6) Bill all family planning services with the most appropriate ICD-10-CM diagnosis code the most appropriate CPT or HCPCS code and add modifier –FP.
7. (7) For annual family planning visits use the appropriate CPT code in the Preventative Medicine series (9938X-9939X) and add modifier -FP. These codes include comprehensive contraceptive counseling.
8. (8) When comprehensive contraceptive counseling is the only service provided at the encounter, use a CPT code from the Preventative Medicine, Individual Counseling series (99401-99404) and add modifier -FP.
9. (9) Bill contraceptive supplies with the most appropriate HCPCS codes.

10. (10) Where there are no specific CPT or HCPCS codes, use an appropriate unlisted code and add modifier -FP. Bill supplies at acquisition cost.

    [ED. NOTE: Forms referenced are available from the agency.]

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.025, 414.065 & 414.152

History

DMAP 51-2015, f. 9-22-15, cert. ef. 10-1-15
DMAP 34-2010, f. 12-15-10, cert. ef. 1-1-11
OMAP 26-2006, f. 6-14-06, cert. ef. 7-1-06
OMAP 45-2005, f. 9-9-05, cert. ef. 10-1-05
OMAP 13-2004, f. 3-11-04, cert. ef. 4-1-04
OMAP 69-2003, f. 9-12-03, cert. ef. 10-1-03
OMAP 23-2003, f. 3-26-03, cert. ef. 4-1-03
OMAP 51-2002, f. & cert. ef. 10-1-02
OMAP 2-2002, f. 2-15-02, cert. ef. 4-1-02
OMAP 13-2001, f. 3-30-01, cert. ef. 4-1-01
OMAP 31-2000, f. 9-29-00, cert. ef. 10-1-00
OMAP 17-1999, f. & cert. ef. 4-1-99
OMAP 3-1998, f. 1-30-98, cert. ef. 2-1-98
HR 4-1997, f. 1-31-97, cert. ef. 2-1-97
HR 10-1996, f. 5-31-96, cert. ef. 6-1-96
HR 42-1994, f. 12-30-94, cert. ef. 1-1-95
HR 6-1994, f. & cert. ef. 2-1-94
HR 40-1992, f. 12-31-92, cert. ef. 2-1-93
HR 8-1992, f. 2-28-92, cert. ef. 3-1-92
HR 43-1991, f. & cert. ef. 10-1-91
HR 19-1991, f. 4-12-91, cert. ef. 5-1-91