Receiving appropriate reimbursement and payment for LARC services provided immediately following an abortion procedure can be challenging. While many payers cover the placement of a LARC method immediately after an abortion, payers may have policies that deny or lower reimbursement for an additional procedure provided on the same day as an abortion.
Medicaid enrollees can choose to receive family planning services from any qualified Medicaid provider, including abortion providers. Medicaid managed care enrollees can receive contraceptive services from any qualified Medicaid provider, including those outside their managed care networks.
Federal Medicaid law allows reimbursement for covered services and supplies that are provided during an abortion visit, even if the abortion does not qualify for Medicaid coverage, so long as those services and supplies are distinguished from and not attributable to the uncovered abortion. However, it appears that some states may have policies in place that create barriers to billing for contraceptive services provided on the same day as an abortion . Title X funds and 340B pricing are available for immediate post-abortion LARC insertion as long as those services and supplies are billed correctly and as a separate procedure. However, there may be other institutional limitations or perceived barriers that create obstacles for implementation.
Billing for multiple services provided during a single visit often results in reduced payments and reimbursement, and can be a barrier to LARC provision with both public payers and commercial plans [4,5]. Some providers have patients return for LARC methods at a separate visit to avoid reduced rates. This additional barrier often results in the patient not coming back to obtain contraception at all.
Strategies for same-day LARC
In many cases a patient may not have abortion coverage or may choose not to use her coverage because of privacy or confidentiality concerns. This patient may still have and want to use coverage for a LARC method immediately post-abortion. Documenting these two services in two separate encounters may be acceptable according to the state or plan’s billing rules about covered services, patient confidentiality, and patient preferences. Providers should check the relevant billing policies to make sure this approach is acceptable in the patient’s particular circumstances.
If it is acceptable to bill for abortion and LARC provision encounters separately, begin when the patient chooses a LARC method on the same day as her abortion procedure. Here are the steps:
- If needed, conduct a benefit verification inquiry with the patient’s insurance plan carrier. See the section on commercial payers for additional information about benefit verification.
- Collect any relevant co-pay or deductible that may apply to the contraceptive portion of the patient’s visit. Note that non-grandfathered plans are required to cover contraception without cost-sharing. See the section on commercial plan coverage requirements for more information about cost-sharing.
- The clinician fills out one encounter form documenting the two procedures. If documenting the encounter in an electronic health record, the clinician may want to open a separate note for the contraception counseling with a distinct diagnosis code in order to document that the E/M services associated with the contraception portion of the visit are distinct and separately identifiable.
- The billing office then produces one claim form for the insurance entity, only for the contraception portion of the visit. The insurance claim should include the procedure code for contraceptive initiation, product J code, diagnosis codes, and E/M code. A CPT code for the tray/supplies may also be recorded, though will often not be reimbursed separately as supplies are generally valued into the procedure code.
This process protects the patient’s privacy and helps mitigate the cost of abortion care and LARC methods provided at the same visit.