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Elizabeth M. Whitehorn, Director

Provider Notice issued 02/01/08

Payment for Essure Micro-inserts

To:​ ​Participating Physicians
​Date: ​February 1, 2008
​Re: Payment for Essure Micro-inserts​

The purpose of this notice is to inform providers that the department has expanded its coverage for the Essure Micro-inserts. Effective with dates of service January 1, 2008, and after, the department will pay for the Essure Micro-inserts for female sterilization performed in a physician’s office.

To receive reimbursement for the inserts, providers will bill CPT code 99070 in the procedure field and the product name in the description field. The reimbursement rate will be $1,245.00. Providers will continue to bill the implant procedure and the post-procedure confirmation test using the appropriate CPT codes for these services. Radiologists may bill the professional component for interpretation of the post-procedure confirmatory films. An HFS 2189, Sterilization Consent Form, must be completed and submitted along with the claim for the insertion procedure. A sample HFS 2189 is available on the department’s Web site. 

Claims submitted for participants in the Illinois Healthy Women program must include the appropriate V25 series diagnosis code to indicate the procedure was for family planning purposes.

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs