October 1, 2018: Hospital and Professional Providers: Long-Acting Reversible Contraception (LARC)

October 1, 2018: Hospital and Professional Providers: Effective for dates of service on and after October 1, 2018 MDHHS will be reimbursing hospitals for immediate postpartum Long-Acting Reversible Contraception (LARC) implants and intrauterine devices (IUDs) separate from the maternity Diagnosis Related Group (DRG). To receive reimbursement hospitals will be required to bill a separate invoice on the electronic professional 837P or CMS-1500 paper claim form using the hospital NPI as the billing and the rendering NPI of the physician that performed the insertion reporting place of service 21 Inpatient hospital. It is also required that all rendering providers be associated to the hospital NPI within their CHAMPS provider enrollment file.

Reporting Requirements:

  • NDC
  • POS
  • HCPCS
  • All appropriate modifiers
    •  340B Drug Pricing Program use modifier U6
  • Professional 1500 claim form

Professional providers will continue to bill for the insertion of the device with their group NPI and rendering NPI being reported on the electronic professional 837P or CMS-1500 paper claim form.