Coding and Reimbursement

ACOG Coding Questions and Assistance Ticket Database (open to all, ACOG members receive priority)

The ACOG Coding department created this database as a place to submit specific OB/GYN coding questions, including those related to LARC. Registration for the database is free, quick, and easy, and registered database users have access to a wide variety of new features including a Coding Committee knowledge base (FAQ), searchable tickets, Coding Questions of the Month, easier ticket submission and tracking and much more. 

Questions may be submitted without registering, but unregistered users should provide the ACOG member name and/or ID on all requests - questions submitted without an associated ACOG physician member name or ID will be assumed to be from a non-member, and responded to as lowest priority. For general information please send questions to HealthEconomics@acog.org.

ACOG LARC Program: The Essential Guide to LARC Coding Webinar

Implementation of the ICD-10 data set the new standard for diagnosis coding in the United States and led to impactful changes to current medical practice. The LARC Program's free webinar on the topic, led by Keisha Sutton, CPC, reviews resources available to help improve reimbursement and payment for LARC. Ms. Sutton also discusses the new policies on reimbursement and coding for LARC methods, including intrauterine devices and the contraceptive implant.

After viewing this webinar, participants will be able to:

  • Explain the appropriate use of CPT-4 and ICD-10-CM for LARC-related services
  • Determine the appropriate code selection and the documentation requirements for reporting Preventive Medicine services according to CPT guidelines
  • Describe resources available to address common LARC-related coding questions 

Download The Essential Guide to LARC Coding webinar handouts here. Find more information and archived LARC Program webinars here.

ACOG District II: A Quick Guide for Reimbursement - Coding for LARC
(ACOG members only)

ACOG District II (serving New York and Bermuda) created this guide to serve as an aid when coding for insertion, removal, and monitoring of IUDs and implants. Codes for related encounters and diagnoses, such as for heavy menstrual bleeding or for incidental pregnancy, are also included.


Other Resources

UCSF: Intrauterine Devices & Implants: A Guide to Reimbursement

This guide from UCSF aims to explain the landscape of LARC public and commercial insurance coverage and serve as a resource for providers navigating stocking,reimbursementreplacementremoval, and special scenarios related to the provision of these methods. The guide is intended to help alleviate financial challenges so that providers are better able to offer the full range of contraceptive methods and minimize out-of-pocket costs or delays in care for their patients.

CMS: State Medicaid Payment Approaches to Improve Access to Long-Acting Reversible Contraception

The Center for Medicaid and CHIP Services (CMCS) issued this informational bulletin to describe payment approaches used by several state Medicaid agencies intended to optimize access and use of long-acting reversible contraception (LARC). This document outlines the state Medicaid payment strategies, including policy descriptions and implementation approaches, used in 14 states to optimize LARC utilization. In addition, the document details LARC optimization strategies, including summaries of the payment and policy approaches, in three selected states (Illinois, Louisiana, and South Carolina).

Kaiser Family Foundation: Medicaid Coverage of Family Planning Benefits - Results from a State Survey

This report from the Kaiser Family Foundation presents findings from a state-level survey on Medicaid family planning benefits, as of July 2015. Medicaid plays a major role financing family planning services for low-income women in the United States, and these services are deemed "mandatory benefits" which must be provided to individuals of childbearing age free of cost-sharing. However, there is no formal federal definition of “family planning,” giving states considerable discretion in determining what specific services are covered. A full PDF of the report can be found here, and click here for an interactive table and map reviewing state-by-state coverage for IUDs and implants both in general and the specific postpartum hospital setting.


The resources listed above are for information purposes only. Referral to these sources and sites does not imply the endorsement of ACOG. Further, ACOG does not endorse any commercial products that may be advertised or available from these organizations or on these web sites. These lists are not meant to be comprehensive. The exclusion of a source or site does not reflect the quality of that source or site. Please note that sites and URLs are subject to change without notice. 

Contact:

Mica Bumpus
Manager, LARC Program
mbumpus@acog.org

For media inquiries about LARC, please contact:
communications@acog.org
202.863.3321

American Congress of Obstetricians and Gynecologists
409 12th Street SW, Washington, DC  20024-2188 | Mailing Address: PO Box 70620, Washington, DC 20024-9998