Current through Register Vol. 56, No. 18, September 16, 2024
(a) Family planning
services include medical history and physical examination (including pelvis and
breast), diagnostic and laboratory tests, drugs and biologicals, medical
supplies and devices, counseling, continued medical supervision, continuity of
care, and genetic counseling. Services provided primarily for the diagnosis and
treatment of infertility, including sterilization reversals, and related clinic
visits, drugs, laboratory services, radiological and diagnostic services, and
surgical procedures are not covered by the New Jersey Medicaid or NJ FamilyCare
fee-for-service program.
1. Exception: When a
service is provided that is ordinarily considered an infertility service, but
is provided for another purpose, then the independent clinic must submit the
claim with supporting documentation for medical review and approval of payment
to the Division of Medical Assistance and Health Services, Office of
Utilization Management, PO Box 712, (Mail Code #14), Trenton, New Jersey
08625-0712.
(b)
Subdermal contraceptive implants are a Medicaid-covered and NJ FamilyCare
fee-for-service-covered service when provided as follows:
1. Subdermal contraceptive implants are used
only in reproductive age women with established regular menstrual
cycles;
2. The Food and Drug
Administration-approved physician prescribing information is followed;
and
3. Patient education and
counseling are provided relating to subdermal contraceptive implants, including
pre- and post-insertion instructions, indications, contraindications, benefits,
risks, side effects, and other contraceptive modalities.
4. A clinic visit relating only to the
insertion or removal of the subdermal contraceptive implants is not
reimbursable on the day of the insertion or removal.
5. Only two insertions and two removals of
subdermal contraceptive implants per beneficiary are permitted during the
FDA-approved clinically appropriate timeframe for the specific
device.
6. The clinic shall not be
reimbursed for subdermal contraceptive implants in conjunction with other forms
of contraception, for example, intra-uterine device.
