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Elizabeth M. Whitehorn, Director

Provider Notice issued 09/21/10

Rate Increase for Permanent Implantable Contraceptive Devices

To:​ Participating Physicians and Advanced Practice Nurses​
Date:​ September 21, 2010​
Re:​ Rate Increase for Permanent Implantable Contraceptive Devices​

The purpose of this notice is to inform practitioners that the department has increased the reimbursement rate for permanent implantable contraceptive devices. Effective August 1, 2010, the department increased the reimbursement rate to $1,550.00 for these devices when practitioners perform the procedure in their office. 

To receive reimbursement for the device, practitioners should bill HCPCS code A4264, permanent implantable contraceptive intratubal occlusion device(s) and delivery system. Practitioners will continue to bill the implant procedure and the post-procedure confirmation test using the appropriate CPT Codes for these services. In addition to the reimbursement rate for the implant procedure, practitioners will be eligible for a $34.00 surgical add-on when performed in the practitioner’s office. No additional coding is necessary to receive the additional reimbursement. An HFS 2189, Sterilization Consent Form, must be completed and submitted along with the claim for the insertion procedure. A sample HFS 2189 (pdf) is available on the department’s Web site.

The department will continue to accept claims for these devices submitted with CPT Code 99070 in the procedure field and the product name in the description field until December 31, 2010. Claims submitted after December 31, 2010, with CPT Code 99070 will be rejected.

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

Practitioners, who have submitted claims for dates of August 1, 2010, and after and were reimbursed $1245.00, may submit an adjustment form to the department to receive the additional $305 difference between the old and new rates. Instructions for completing an adjustment form are in Chapter 100, General Appendix 6, located on the department’s Web site.

If you have any questions regarding this notice, please contact the Bureau of Comprehensive Health Services at 1-877-782-5565.

Theresa A. Eagleson, Administrator

Division of Medical Programs