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Request for an 1115 Waiver to Provide Family Planning Coverage to Women ... reducing the social and economic costs assoc
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Request for an 1115 Waiver to Provide Family Planning Coverage to Women and Men between the Ages of 18 and 49 with Gross Income Below 200 Percent of Poverty Prepared by New Jersey Division of Medical Assistance and Health Services New Jersey Department of Human Services October 2009 New Jersey is applying for this waiver to create a program called the NJ Family Planning Expansion Project with the purpose of expanding family planning services to a new population of women; which will help them plan their pregnancies therefore reducing the social and economic costs associated with unintended and mistimed pregnancies. It intends to cover women and men between the ages of 18 and 49 with income equal to or below 200% of the federal poverty level (FPL). Background The New Jersey Department of Human Services (NJ DHS), Division of Medical Assistance and Health Services (NJ DMAHS), administers the Medicaid and NJ FamilyCare programs. The Medicaid program provides health insurance to parents/caretakers and dependent children, pregnant women and people who are aged, blind or disabled. The NJ FamilyCare program is a health insurance program for uninsured children whose family income is too high for them to qualify for “traditional” New Jersey Medicaid but not high enough to be able to afford private health insurance. Some low-income uninsured parents/caretakers are also eligible for NJ FamilyCare. Currently, there are over 1 million beneficiaries enrolled in NJ FamilyCare/Medicaid. NJ FamilyCare/Medicaid currently covers pregnant women with income equal to or below 200% FPL. These women are covered 60-days post partum before being terminated from the program. NJ FamilyCare/Medicaid does not cover women if they are over 20, have no dependent children, are not pregnant or disabled. Currently, women in New Jersey who do not have private health coverage must pay for family planning services themselves or seek services at Title X family planning clinics, which are funded by a federal grant program to provide family planning services, or a Federally Qualified Health Center (FQHC). Current Situation New Jersey has a population of 8.7 million residents, 51% of which are females. Almost 42% of the women in New Jersey are in their childbearing years (15-44 years of age). Over 131,000 individuals including over 123,000 women and over 8,000 men used a Title X clinic in 2008 and over 126,000 are under 200% federal poverty level (FPL) of which over 65,000 were uninsured . i The Federally Qualified Health Centers had over 19,000 women access their clinics for family planning services.
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According to the Guttmacher Institute, “In New Jersey, over 211,000 of the 1.8 million women of childbearing age becomes pregnant each year. Fifty-five percent of these pregnancies result in live births and 31% result in abortions; the remainder end in miscarriage.” ii Over 1 million women in New Jersey are in need of contraceptive services and supplies. Almost 400,000 of these women have incomes below 250% FPL and are in need of publicly supported family planning services. iii “In New Jersey, 9% of women aged 15-44 have incomes below the federal poverty level, and 20% of all women in this age-group are uninsured.” iv According to the NJ Center for Health Statistics, over the past several decades, birth rates have declined among younger women while rising among older women…more that half of births (55%) occurred to women aged 25-34 years. v The Guttmacher Institute Contraception Counts states, “the United State has one of the highest rates of unintended pregnancy in the industrialized world…and states can play an active role in women avoiding unintended pregnancies.” vi Nationally, about 60% of all pregnancies are unintended, mistimed or unwanted. vii An estimated one out of every three recent births in New Jersey was either mistimed (26%) or unwanted (8%) pregnancy. viii There are many risks associated with unintended pregnancies. Women with unintended pregnancies are 1.6 times more likely to delay entry into prenatal care, which can increase the health risks for the mother and baby. ix x xi xii Unintended or mistimed pregnancies can lead to complications including pre-term delivery and low birth weight. xiii xiv xv In New Jersey, 10% of all births are preterm and 8% of babies have low birth weight.
Project Goals and Objectives This project will allow NJ FamilyCare/Medicaid to expand family planning services to a new population of women and men. The project goal and objectives for the NJ Family Planning Expansion project is to help women plan their pregnancies therefore reducing the social and economic costs associated with unintended and mistimed pregnancies. Goal Reduce the number of unintended and mistimed pregnancies and improve maternal health and newborn outcomes Objectives o Increase the number of women and men receiving family planning services from Medicaid o Reduce the number of pregnancies for the women in the waiver population o Reduce the proportion of Medicaid births spaced less than two years apart for women in the waiver population
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o Decrease the number of Medicaid paid pregnancies and deliveries, which will reduce annual expenditures for prenatal care, delivery and newborn care. Project Design Provider Network New Jersey intends to use the current Title X clinics and the FQHCS as the provider network for this project. Family planning clinics in New Jersey play a vital role in the reproductive health of low-income women. According to the Center for Reproductive Rights, family planning clinics “serve as an entry point into the health-care system for young women and low-income people in this country…and offer contraceptive services and education that prevent unintended pregnancy, testing and treatment for sexually transmissible infections, and other primary reproductive health care.” xvi In New Jersey, publicly funded family planning clinics help women prevent 30,200 unintended pregnancies each year.” xvii There are currently 16 Title X agencies with 55 operating clinic sites statewide, with at least one in every county, and all are enrolled as Fee-For-Service (FFS) Medicaid providers. In New Jersey there are two Title X grantees, the Department of Health and Senior Services and the New Jersey Family Planning League. The Title X Federal funds are allocated through 11 New Jersey Department of Health and Senior Services delegate agencies and 5 New Jersey Family Planning League delegate agencies. See Appendix A for a complete list of clinics. The FQHCs in New Jersey provide comprehensive community-based primary health care with an emphasis on maternal and child health which seeks to provide quality care for people from prenatal to old age. xviii There are currently 20 FQHCs statewide, with 99 operating clinics serving 19 of the 21 counties. See Appendix B for a complete list of FQHCs.
Primary Care Referrals When a woman or man applies for the NJ Family Planning Expansion Program, it is required as part of this waiver that the provider make the necessary primary care referral. When appropriate the Title X clinics may refer clients to the FQHCs and the FQHCs may refer to the Title X clinics. The Title X clinics and FQHCs have an existing relationship and refer clients on an on-going basis. The New Jersey Primary Care Association, the organization that represents the FQHCs, is supportive of the NJ Family Planning Expansion Project to provide Medicaid family planning services to more women in New Jersey. See Appendix C for their letter in support of this waiver.
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Eligible Population The NJ Family Planning Expansion Project will expand family planning services to qualified women and men between the ages of 18-49 with gross income equal to or below 200% FPL. Table 1 shows the number of women and men we estimate to be eligible and accessing services for each demonstration year based on the number of woman and men currently accessing services at the Title X clinics and FQHCs for family planning services.
Table 1 Year Year 1 Year 2 Year 3 Year 4 Year 5
Enrollment 66,057 67,793 69,601 71,485 73,451
Eligibility Determination New Jersey will be using a Point-of-Service Application to determine eligibility for women and men between the age of 18 and 49 who present at clinics for family planning services who do not otherwise qualify for NJ FamilyCare/Medicaid. The use of Point-of Service application allows the applicant to apply and obtain family planning services immediately and that the provider is reimbursed for these services. An electronic application will be completed at the clinic. The electronic application will then be sent to the statewide eligibility determination agency for processing – the on-line application will mirror the NJ FamilyCare/Medicaid online application. The application captures information about income, health insurance, family size and citizenship/immigration status. The applicant will be allowed to self-declare income. The clinic will not be responsible for obtaining proof of income, however the statewide eligibility determination agency staff will be required to check existing databases to verify that the income provided is accurate. If the income cannot be verified the vendor will ask for additional income information from the applicant, such as pay stubs or tax returns. The statewide eligibility determination agency will have the ability to use existing databases to verify the citizenship/immigration status if necessary, therefore helping to expedite the enrollment process. Once a final eligibility determination has been made a card will be sent to the client and the clinic can verify eligibility in the system and bill for the services provided on the initial visit.
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Eligibility Redetermination Process The statewide eligibility determination agency will renew those enrolled in the NJ Family Planning Expansion Project annually, using an administrative renewal process if possible. Otherwise, a pre-printed renewal form will be sent 75 days before their 12month period of eligibility ends and one reminder notice 45 days before termination. Covered Services The Family Planning Expansion Project will cover family planning services currently provided through NJ FamilyCare/Medicaid for women and men through family planning clinics, FQHCs and hospitals. See Appendix D for a list of covered services.
Outreach Outreach will be important for the success of this program, enabling us to maximize enrollment of eligible women and men. Brochures and posters will be developed with information about the NJ Family Planning Expansion Project and will be made available at various agencies throughout New Jersey including Title X clinics, Federally Qualified Health Centers, Hospitals, Maternal and Child Heath Consortia, Healthy Mothers Health Babies, WIC, Local County Welfare Agencies, NJ FamilyCare Outreach offices and Medical Assistance Customer Centers. DMAHS will be updating their general NJ FamilyCare/Medicaid training module, presented to various groups statewide. In addition they will train clinic staff on the program eligibility requirements and completing the on-line application. Public Process An Interdepartmental workgroup, with the Department of Human Services and Department of Health and Senior Services, was established to develop the NJ Family Planning Expansion project in New Jersey. Staff from these two departments met on a regular basis to develop the waiver application. Staff from the Department of Human Services and Department of Health and Senior Services met with members of the NJ Family Planning Association, NJ Family Planning League and Planned Parenthood to discuss the proposed NJ Family Planning Expansion project. They were given an opportunity to review the waiver application and offer comment. We have incorporated many of the recommendations suggested by these groups. Commissioner Heather Howard from the New Jersey Department of Health and Senior Services convened a Prenatal Task Force in February 2008. The Task Force
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included experts in the field of Maternal and Child Health. The Commissioner’s Task Force on Prenatal Care found that unintended pregnancy or a lack of awareness of a pregnancy can delay the initiation of early prenatal care. The Task Force strongly recommended that efforts to improve access to early prenatal care must address the factors related to unintended pregnancy and lack of early pregnancy awareness by focusing on women before they become pregnant. Governor Corzine held a forum on the benefits of expanding family planning services, which was attended by over 40 advocates, healthcare and family planning providers. The family planning waiver was major point of discussion at this forum. It was a chance for advocates to voice their issues, concerns and recommendations on how to improve the process. The final submitted version of the waiver request is posted on the Department of Human Services website. Notices posted in newspapers, medical assistance customer centers, county welfare agencies, and on the DHS website will advise that the waiver request is being submitted to CMS, and offer the opportunity for additional comments. Proposed rules are being drafted. There will be a 60 day public comment period before adoption of the final regulations.
Project Administration The New Jersey Department of Human Services, Division of Medical Assistance and Health Services, administers the NJ FamilyCare/Medicaid in New Jersey. For the NJ Family Planning Expansion Project, clients will be enrolled in Fee-for-Service (FFS) Medicaid. Women and men can apply and receive services through one of the Title X clinics or FQHCs statewide who are also Medicaid FFS providers. Our Statewide Eligibility Determination Agency will process the applications for this project. Evaluation The following hypotheses have been developed to help New Jersey demonstrate the effectiveness of their waiver over five years to meet the goals and objectives that have been outlined for this project. Hypothesis 1:
The demonstration waiver will result in an increase in number of eligible women and men aged 18-49 receiving Medicaid paid family planning services in New Jersey. xix
Measure:
The number of women and men who receive a Medicaid paid family planning service to be measured at the end of every waiver year.
Data required:
The number of women and men uniquely identified as part of the waiver receiving a Medicaid paid family planning service.
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Data Source:
New Jersey’s Medicaid Management Information System (NJMMIS), which captures claim and financial information for all Medicaid recipients.
Hypothesis 2:
The demonstration waiver will result in the reduction of pregnancies of women aged 18-49 enrolled in the NJ Family Planning Expansion Project compared to pregnancies among all New Jersey women between 18 and 49.
Measure:
The number of pregnancies experienced by a sample population of women after enrolling in the waiver as compared to the number of self-reported pregnancies of women in the waiver population prior to them enrolling in the waiver.
Data required:
Enrollment data from claims information from NJMMIS, statewide eligibility determination agency report from the on-line application
Data source:
Statewide eligibility determination agency reports and NJMMIS
Hypothesis 3:
The demonstration waiver will result in an increased spacing of pregnancies among women aged 18-49 enrolled in the NJ Family Planning Expansion Project.
Measure:
The spacing of pregnancies experienced by a sample population of women with a Medicaid paid birth during a specific fiscal year that has a subsequent Medicaid paid birth within two years.
Data required:
Eligibility and claims information from NJMMIS
Data source:
NJMMIS
Hypothesis 4:
The demonstration waiver will produce a net annual savings in State and Federal Medicaid expenditures for birth-related services per women aged 18-49 in the Medicaid program. xx
Measure:
The estimated fiscal year Medicaid savings from births prevented by the waiver less fiscal year Medicaid family planning expenditures for the waiver target population, based on a sample of women who used the Title X clinic and subsequently enrolled in the waiver
Data required:
The difference between the expected number of Medicaid paid births, due to a conception in a given fiscal year, to the waiver target population and the actual number of Medicaid paid births to this population multiplied by the average associated prenatal, birth,
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newborn and infant care costs. The total fiscal year Medicaid family planning expenditures for the waiver target population. Data Source:
New Jersey Medicaid Management Information System, which includes claim and financial information.
Conclusion This waiver application has outlined the need for this project in New Jersey. The challenge is how to get those women who have never obtained family planning services, as well as those who have received them but have fallen off the Medicaid roles after giving birth, to make family planning a part of their everyday lives. Our hope is to cultivate in those whom we enroll in the NJ Family Planning Expansion Project a realization that regularity in obtaining these services is an important part of their reproductive health and quality of life. This project’s goal is to make it easier for women of child bearing age to obtain routine family planning services and care, and to ensure these services are ongoing by maintaining continuous enrollment in the NJ Family Planning Expansion Project.
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Appendices Appendix A
New Jersey Family Planning Agencies/Clinic Sites by County, 2008 (16 agencies / 55 clinic sites operating) ATLANTIC Planned Parenthood of Southern New Jersey • •
• Bridgeton • Vineland • Millville ESSEX Planned Parenthood of Metropolitan New Jersey
Atlantic City Pomona (Stockton State College)
BERGEN Planned Parenthood of Greater Northern New Jersey • •
• • • •
Englewood Hackensack
North Hudson Community Health Center •
Newark Beth Israel Medical Center •
Garfield
BURLINGTON Burlington County Health Department • •
•
Westampton – Main site for agency Browns Mills
• •
Edgewater Park
Glassboro – Main site for agency Glassboro (Rowan University)
HUDSON Horizon Health Center •
Camden – Main site for agency Bellmawr Cherry Hill
Jersey City – Only site for agency
Bayonne Department of Health Women’s Health Center
CAPE MAY Cape May County Department of Health •
Newark – Only site for agency
GLOUCESTER FamCare
CAMDEN Planned Parenthood of Southern New Jersey • • •
Newark/Irvington – Only site for agency
UMDNJ – University OB/GYN Associates
Planned Parenthood of Southern New Jersey •
Newark (Downtown) – Main site for agency Newark (Ironbound) Montclair East Orange
•
Cape May Court House – Only site for agency
Bayonne – Only site for agency
Hoboken Family Planning • •
CUMBERLAND FamCare
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Hoboken – Main site for agency West New York
• •
North Hudson Community Health Center • • • •
West New York – Main site for agency Union City Jersey City North Bergen
North Hudson Community Health Center • •
•
Flemington
• •
•
Trenton (Downtown) – Main site for agency Hamilton Square Trenton (College of New Jersey)
•
New Brunswick Perth Amboy Spotswood
•
• •
Shrewsbury – Main site for agency Freehold Hazlet
Elizabeth Plainfield
WARREN Planned Parenthood of Greater Northern New Jersey •
Morristown – Main site for agency Dover
OCEAN Family Planning Center of Ocean County •
Newton
UNION Planned Parenthood of Greater Northern New Jersey
MORRIS Planned Parenthood of Greater Northern New Jersey • •
Somerville – Only site for agency
SUSSEX Planned Parenthood of Greater Northern New Jersey
MONMOUTH Planned Parenthood of Central New Jersey • • •
Manville
Women’s Health and Counseling Center
MIDDLESEX Planned Parenthood of Central New Jersey • • •
Pennsville
SOMERSET Planned Parenthood of Greater Northern New Jersey
MERCER Planned Parenthood Association of the Mercer Area •
Passaic (Main Avenue) Passaic (8th Street)
SALEM FamCare
HUNTERDON Planned Parenthood of Greater Northern New Jersey •
Paterson Pompton Lakes
Lakewood – Only (current) site for agency
PASSAIC Planned Parenthood of Metropolitan New Jersey
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Phillipsburg
Appendix B
New Jersey Federally Qualified Health Centers Newark Community Health Centers 741 Broadway Newark, New Jersey 07104 Newark Homeless Health Care Project 110 William Street, Room 200 Newark, NJ 07102
AtlantiCare Health Services Mission Health Care 2009 Bacharach Blvd. Atlantic City, New Jersey 08401 Camcare Health Corporation Gateway Health Center 817 Federal Street Camden, New Jersey 08103
North Hudson Community Action Corporation 5301 Broadway West New York, New Jersey 07093
Community Health Care PO Box 597 105 Manheim Avenue Bridgeton, New Jersey 08302
Ocean Health Initiatives, Inc. 101 Second Street Lakewood, New Jersey 08701
Eric B. Chandler Health Center 277 George Street New Brunswick, New Jersey 08901
Paterson Community Health Center 32 Clinton Street Paterson, New Jersey 07522
Henry J. Austin Health Center 321 North Warren Street Trenton, New Jersey 08618
Plainfield Health Center 1700-58 Myrtle Avenue Plainfield, New Jersey 07063-1038
Horizon Health Center 714 Bergen Avenue Jersey City, New Jersey 07306
Project H.O.P.E., Inc. Bergen Lanning Health Center 439 Clinton Street Camden, New Jersey 08103
Jewish Renaissance Health Center 272A Hobart Street Perth Amboy, New Jersey 08862
Southern Jersey Family Medical Centers 1 White Horse Center Hammonton, New Jersey 08037
Lakewood Resource and Referral Center, Inc. 1771 Route 9 Lakewood, NJ 08701 Metropolitan Family Health Network, Inc. 935 Garfield Avenue Jersey City, New Jersey 07304
Visiting Nurse Services of Central Jersey Community Health Center 1301 Main Street Asbury Park, New Jersey 07712
Monmouth Family Health Center 270 Broadway Long Branch, New Jersey 07740
Zufall Health Center 17 S. Warren Street Dover, New Jersey 07801
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Appendix C
NJPCA ________________________________________________________________________________________________ New Jersey Primary Care Association, Inc.
Katherine Grant-Davis President & CEO
March 25, 2009 John Guhl Director Department of Human Services Division of Medical Assistance and Health Services PO Box 712 Trenton, NJ 08625-0712 Dear Mr. Guhl; On behalf of the New Jersey Primary Care Association (NJPCA), I am pleased to write this letter of support for your Family Planning Waiver to provide family planning coverage to women between the ages of 18 and 49 with income under 200% of the federal poverty level. As you know, NJPCA is a not-for-profit organization that represents Federally Qualified Health Care (FQHC) centers statewide, serving over 350,000 patients in 19 of the 21 counties. FQHCs have a particular emphasis on maternal and child health and providing quality primary care from prenatal to old age. NJPCA has worked collaboratively with the Division of Medical Assistance and Health Services (DMAHS) on a number of projects over the years and look forward to working on the development and implementation of the New Jersey Family Planning Expansion Project and playing an active role as a part of the provider network as well as supporting the referral for primary care to our FQHCs for this new eligibility group. Sincerely,
Katherine Grant-Davis President and CEO KGD:DVZ
3836 Quakerbridge Road, Suite 201, Hamilton, NJ 08619 (609) 689-9930 FAX (609) 689-9940/41
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Appendix D Family Planning Codes
Procedure Code
Proc Layman Name
Proc AHSF Desc
Proc Valid Gender Code
11975
INSERT/REINSERT IMPLANT.CONTRA
ALWAYS FAMILY PLANNING
F
11975
INSERT/REINSERT IMPLANT,CONTA
ALWAYS FAMILY PLANNING
F
11975
INSERT/REINSERT IMPLANT,CONTA
F
11976
REMOVE WO REINSERT IMPL.CON.CA
11976
REMOVE WO REINSERT,IMPL.CON.CA
11976
REMOVE WO REINSERT,IMPL.CON.CA
11977
REM.REINS.IMPLANT CONTRA.CAPS.
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
11977
REM.REINS.IMPLANT CONTR.CAPS.
ALWAYS FAMILY PLANNING
F
11981
INSERT NON-BIO DRUG DELIV IMPL
F
11981
INSERT NON-BIO DRUG DELIV IMPL
11982
REMOVAL NON-BIO DRUG DELIV IMP
11982
REMOVAL NON-BIO DRUG DELIV IMP
11983
REM W/INS NON-BIO DRUG DEL IMP
11983
REM W/INS NON-BIO DRUG DEL IMP
36415
ROUTINE VENIPUNCTURE FOR COLLE
36415
ROUTINE VENIPUNCTURE FOR COLLE
36415
ROUTINE VENIPUNCTURE FOR COLLE
36416
COLLECT CAP BLOOD SPECIMEN
37788
PENILE RENASCUL.ARTERY,W/WO VG
52010
CYSTOSCOPY W/ DUCT CATHETER
54056
DESTROY PENILE LESION;CRYOSURG
54300
PLASTIC REPAIR FOR CHORDEE
54304
REVISE PENIS/CORRECT CHORDEE
54308
URETHROPLASTY...LESS THAN 3 CM
54312
URETHROPLASTY...;MORE THAN 3 C
54316
URETHROPLASTY/RELEASE FROM SCR
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
13
F F F F
B F B F B B B B B M B M M M M M M
Procedure Code
Proc Layman Name
54318
3RD STAGE HYPOSPADIAS REPAIR
54322
ONE STAGE REP,W/ SIMP.MEATAL A
54324
1 STAGE REP.URETHROPLASTY-SKIN
54326
1 STAGE REP.URETHROPLASTY-MOB.
54328
1 STAGE REP,CORRECT CHORDEE&UR
54332
1 STAGE PROX PEMILE/PENOSCROTA
54336
1 STAGE PERINEAL HYPOSPADIAS R
54340
REP.HYPOSPADIAS COMPLICATIONS,
54344
REP.HYPOSPADIAS COMPLICATION/F
54348
REP.HYPOSPADIAS COMPLICATION/E
54352
REP HYPOSPADIAS CRIPPLE...EXTE
54360
PLASTIC PENILE REPAIR/ANGULATI
54400
INSERT PENILE PROSTH,NON-INFLA
54401
INSERTION OF PENILE PROSTHESIS
54405
INSERT INFLATABLE PENILE PROST
54450
PREPUTIAL STRETCHING
54500
BIOPSY OF TESTIS
54505
BIOPSY OF TESTIS
54830
REMOVE EPIDIDYMIS LESION
55200
INCISION OF SPERM DUCT
55250
VASECTOMY, UNILATERAL OR BILAT
55300
PREPARATION,SPERM DUCT X-RAY
55450
LIGATION OF VAS DEFERENS
55520
REMOVAL OF SPERM CORD LESION
55530
REVISE SPERMATIC CORD VEINS
14
Proc AHSF Desc
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS STERILIZATION SOMETIMES FAMILY PLANNING ALWAYS STERILIZATION SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
Proc Valid Gender Code M M M M M M M M M M M M M M M M M M M M M M M M M
Procedure Code
Proc Layman Name
55535
REVISE SPERMATIC CORD VEINS
55540
REVISE HERNIA & SPERM VEINS
55600
INCISE SPERM DUCT POUCHES
55600
VESICULOTOMY;
55605
INCISE SPERM DUCT POUCH
55680
REMOVE SPERM POUCH LESION
55870
ELECTROEJACULATION
56501
DESTRY VULVA LESION(S);SIMPLE
57100
BIOPSY OF UTERUS LINING
57160
INSERT PESSARY
57170
FITTING OF DIAPHRAGM
57335
VAGINOPLASTY/ADRENOGENITAL SYS
57410
PELVIC EXAM UNDER ANESTHESIA
57415
REM. IMP. UNDER ANESTHESIA
57452
Proc AHSF Desc
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
Proc Valid Gender Code M M M M M M M F F
EXAMINATION OF VAGINA
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
57454
VAGINA EXAMINATION & BIOPSY
ALWAYS FAMILY PLANNING
F
57460
COLPOSCOPY;W/LOOP ELECT EXCIS
ALWAYS FAMILY PLANNING
F
57500
BIOPSY OF CERVIX
F
57505
ENDOCERVICAL CURETTAGE
57511
CRYOCAUTERY OF CERVIX
57720
REVISION OF CERVIX
57800
DILATION OF CERVICAL CANAL
57800
DILATION OF CERVICAL CANAL
58100
BIOPSY OF UTERUS LINING
58100
BIOPSY OF UTERUS LINING
58100
BIOPSY OF UTERUS LINING
58120
DIAGNOSTIC/THERAPEUTIC D&C
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
15
F F F F F F
F F F F F F F F F
Procedure Code
Proc Layman Name
Proc AHSF Desc
Proc Valid Gender Code
58140
REMOVAL OF UTERUS LESION
58145
REMOVAL OF UTERUS LESION
58300
IUD BY CNP/CNS IN FPC
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
58300
INSERT IUD BY CNM IN FPC
ALWAYS FAMILY PLANNING
F
58300
IUD IN FPC
ALWAYS FAMILY PLANNING
F
58300
IUD BY CNP/CNS
ALWAYS FAMILY PLANNING
F
58300
INSERT IUD BY CNM
ALWAYS FAMILY PLANNING
F
58300
INSERT INTRAUTERINE DEVICE
ALWAYS FAMILY PLANNING
F
58301
REMOVE IUD BY CNP/CNS IN FPC
F
58301
REMOVE IUD BY CNM IN FP CLINIC
58301
REMOVE INTRAUTERINE DEVICE
58301
REMOVAL OF IUD BY CNM
58301
REMOVE INTRAUTERINE DEVICE
58340
INJECT FOR UTERUS/TUBE X-RAY
58400
UTERINE SUSPENSION
58540
REPIAR OF UTERINE ANOMALY
58565
HYSTEROSCOPY, STERILIZATION
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS STERILIZATION
58600
DIVISION OF FALLOPIAN TUBE
ALWAYS STERILIZATION
F
58605
DIVISION OF FALLOPIAN TUBE
ALWAYS STERILIZATION
F
58611
LIGATION/TRANSECT FALLOPIAN TU
ALWAYS STERILIZATION
F
58615
OCCLUSION OF FALLOPIAN TUBE, D
F
58660
SURG LAP W/LYSIS OF ADHESIONS
58670
SURG LAP W/FULG OF OVIDUCTS
ALWAYS STERILIZATION SOMETIMES FAMILY PLANNING SOMETIMES STERILIZATION
58671
SURG LAP W/OCCLUS OF OVIDUCTS
ALWAYS STERILIZATION
F
58700
REMOVAL OF FALLOPIAN TUBE
SOMETIMES STERILIZATION
F
58720
COMP/PART SALPINGO-OOPHORECTOM
F
58740
LYSIS OF ADHESIONS TUBES/OVARY
58750
PLASTIC REPAIR OF FALLOPIAN TU
58752
TUBOUTERINE IMPLANTATION
58760
FIMBRIOPLASTY
58770
SALPINGOSTOMY(SALPINGONEOSTOMY
SOMETIMES STERILIZATION SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY
16
F F F
F F F F F F F F
F F
F F F F F
Procedure Code
Proc Layman Name
Proc AHSF Desc
Proc Valid Gender Code
PLANNING 58900
BIOPSY OF OVARY(S)
74740
X-RAY FEMALE GENITAL TRACT,S&I
76856
ECHOGRAPHY, PELVIC, REAL TIME
76857
ECHOGRAPHY, PELVIC, LIMITED
76857
ECHOGRAPHY, PELVIC,LIMITED OR
76948
ECHOGRAPHY,SCROTUM AND CONTENT ULTRASONIC GUIDE,ASPIRE OVA,
81000
URINALYSIS WITH MICROSCOPY
81000
URINALYSIS WITH MICROSCOPY
81000
URINALYSIS WITH MICROSCOPY
81002
ROUTINE URINE ANALYSIS
81002
ROUTINE URINE ANALYSIS
81025
URINE PREG.TEST;VISUAL COLOR
81025
URINE PREG.TEST;VISUAL COLOR
81025
URINE PREG.TEST;VISUAL COLOR
82160
ANDROSTERONE; RIA
82465
ASSAY SERUM CHOLESTROL
82465
ASSAY SERUM CHOLESTEROL
82947
ASSAY BODY FLUID GLUCOSE
82947
ASSAY BODY FLUID, GLUCOSE
82947
ASSAY BODY FLUID, GLUCOSE
82948
STICK ASSAY OF BLOOD GLUCOSE
83516
IMMUNOASSAY FOR ANALYTE QUAL
83518
IMM.ANALYTE ANTIBODY QUAL.SEMI
83518
IMM.ANALYTE ANTIBODY QUAL.SEMI
84066
ASSAY PROSTATE PHOSPHATASE, RI
76870
17
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
F F B B B M F B B B B B F F F B B B B F B B B B B M
Procedure Code
Proc Layman Name
84702
GONADOTROPIN,CHORIONIC;QUANTIT
84702
GONADOTROPIN,CHORIONIC;QUANTIT
84703
GONADOTROPIN,CHORIONIC;QUALITA
84703
GONADOTROPIN,CHORIONIC;QUALITA
84703
GONADOTROPIN,CHORIONIC;QUALITA
85013
BLOOD COUNT SPUN MICROHEMATOCR
85013
BLOOD COUNT;SPUN MICROHEMATOCR
85018
HEMOGLOBIN, COLORIMETRIC
86255
FLUORESCENT ANTIBODY; SCREEN
86255
FLUORESCENT ANTIBODY; SCREEN
86256
FLUORESCENT ANTIBODY; TITER
86256
FLUORESCENT ANTIBODY; TITER
86359
T CELLS;TOTAL COUNT
86360
T CELLS;T4&T8, INCLUDING RATIO
86592
SYPHILIS TEST(S) ,QUALITATIVE
86592
SYPHILIS TEST(S),QUALITATIVE
86592
SYPHILIS TEST(S),QUALITATIVE
86593
SYPHILIS TEST, QUANTITATIVE
86631
ANTIBODY;CHLAMYDIA
86632
ANTIBODY;CHLAMYDIA, 1GM
86674
ANTIBODY;GIARDIA LAMBLIA
86687
HTLV I ANTI DECT IMMUNOASSAY
86688
ANTIBODY;HTLV-II
86689
HTLV I ANIT DECT CONFIRM TEST
86694
ANTIBODY;HERPES SIMPLEX,WONSPE
18
Proc AHSF Desc
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
Proc Valid Gender Code F F F F F B B B B B B B B B B F B B B B B B B B B
Procedure Code
Proc Layman Name
86695
ANTIBODY;HERPES SIMPLEX,TYPEI
86695
ANTIBODY;HERPES SIMPLEX,TYPE I
86696
HERPES SIMPLEX TYPE 2
86701
ANTIBODY:HIV 1
86701
ANTIBODY; HIV-1
86701
ANTIBODY:HIV 1
86702
ANTIBODY:HIV 2
86703
ANTIBODY;HIV-1&2,SINGLE ASSAY
86703
ANTIBODY;HIV-1&2,SINGLE ASSAY
86703
ANTIBODY;HIV-1&2,SINGLE ASSAY
86703
ANTIBODY;HIV-1&2,SINGLE ASSAY
86703
ANTIBODY;HIV-1&2,SINGLE ASSAY
86729
ANTIBODY;LYMPHOGRANULOMA VENER
86762
ANTIBODY;RUBELLA
86762
ANTIBODY;RUBELLA
86762
ANTIBODY;RUBELLA
86781
ANTIBODY; TREP.PALL.CONF.TEST
87075
CULTURE SPECIMEN, BACTERIA
87076
BACTERIA IDENTIFICATION
87086
URINE CULTURE,COLONY COUNT
87086
URINE CULTURE, COLONY COUNT
87110
CULTURE,CHLAMYDIA
87164
DARK FIELD EXAMINATION
87164
DARK FIELD EXAMINATION
87184
ANTIBIOTIC SENSITIVITY,EACH
87184
ANTIBIOTIC SENSITIVITY, EACH
87205
SMEAR, STAIN & INTERPRET, ROU
19
Proc AHSF Desc
Proc Valid Gender Code
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
B
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY
B
B B B F B B B
B F B B F F B B B B B B B B B B B B
Procedure Code
Proc Layman Name
Proc AHSF Desc
Proc Valid Gender Code
PLANNING 87207
SMEAR, STAIN & INTERPRET, SPEC
87210
SMEAR, STAIN & INTERPRET, WET
87220
TISSUE EXAMINATION FOR FUNGI
87250
VIRUS INOCULATION FOR TEST
87270
CHAMYDIA TRACHOMATIS
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
87274
HERPES SIMPLEX VIRUS
ALWAYS FAMILY PLANNING
B
87320
INFECTIOUS AGENT CHLAMYDIA TRA
ALWAYS FAMILY PLANNING
B
87490
INFECT-AG-NUCLEIC-CHAMYDIA TRA
ALWAYS FAMILY PLANNING
B
87491
INFECT AG DECT DNA CHLAMYDIA
ALWAYS FAMILY PLANNING
B
87590
NEISSERIA GONORRHOEAE D-PROBE
ALWAYS FAMILY PLANNING
B
87591
NEISSERIA GONORRHOEAE AMPL
ALWAYS FAMILY PLANNING
B
87620
PAPILLOMAVIRVS-HUMAN- DIR-PROB
ALWAYS FAMILY PLANNING
B
87621
PAPILOMAVIRUS AMPL
ALWAYS FAMILY PLANNING
B
88141
CYTOPATH CER-VAG ANY REP
F
88141
CYTOPATH CER-VAG ANY REP
88142
CYTOPATH -AUTOMATED THIN PREP
88142
CYTOPATH -AUTOMATED THIN PREP
88143
CYTOPATH C/VAG T/LAYER MAN RE
88143
CYTOPATH C/VAG T/LAYER MAN RE
88147
CYTO/PATH C/VAG AUTOMATED P/S
88147
CYTO/PATH C/VAG AUTOMATED P/S
88148
CYTO/PATH C/VAG AUTO RESC
88148
CYTO/PATH C/VAG AUTO RESC
88150
CYTOPATHOLOGY, PAP SMEAR
88150
CYTOPATHOLOGY, PAP SMEAR
88152
CYTOPATH, W/MANUEL CYTO SCREEN
88152
CYTOPATH, W/MANUEL CYTO SCREEN
88153
CYTO/PATH C/VAG REDO
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
20
B B B B B
F F F F F F F F F F F F F F
Procedure Code
Proc Layman Name
88153
CYTO/PATH C/VAG REDO
88154
CYTOPATH C/VAG SELECT C/PHY S
88154
CYTOPATH C/VAG SELECT C/PHY S
88155
CYTOPATH,(PAP);W/ DEF.HORMONAL
88164
CYTOPATH SLIDES C/VAG MANUAL
88164
CYTOPATH SLIDES C/VAG MANUAL
88165
CYTOPATH TBS C/VAG REDO
88165
CYTOPATH TBS C/VAG REDO
88166
CYTOPATH TBS SYS C/VAG AUTO
88166
CYTOPATH TBS SYS C/VAG AUTO
88167
CYTOPATH TBS/SYS C/VAG SELECT
88167
CYTOPATH TBS/SYS C/VAG SELECT
88175
CYTO W/SCR BY AUTO, THIN LAYER
88305
COLPOSCOPY PATHOLOGY
89310
SEMEN ANALYSIS
89320
COMPLETE SEMEN ANALYSIS
89325
SPERM ANTOBODIES
89329
Proc AHSF Desc
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
Proc Valid Gender Code F F F F F F F F F F F F F B
SPERM EVAL.HAMSTER PENETRATION
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
89330
CERVICAL MUCUS PENETRATION TES
ALWAYS FAMILY PLANNING
B
90649
H PAPILLOMA VACC 3 DOSE IM
B
90706
IMMUNIZATION RUBELLA
90707
IMMUNIZATION ACTIVE MEASLES MU
90707
IMMUN MEASLES-MUMPS-RUBELLA
90746
HEPATITIS B VACCINE >19
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
90772
THER/PROPH/DIAG INJ, SC/IM
B
90772
THER/PROPH/DIAG INJ, SC/IM
96372
THERAPEUTIC PROPHY/DIAG INJECT
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
21
M M M M
B B B B
B B
Procedure Code
Proc Layman Name
Proc AHSF Desc
Proc Valid Gender Code
96372
THERAPEUTIC PROPHYLACTIC OR
99201
E/M INITIAL FP VS IN FP CLINIC
SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99201
E/M INIT BRIEF FP VS/CNM FP CL
ALWAYS FAMILY PLANNING
F
99201
E/M INITIAL FP VS IN FP CLINIC
B
99201
E/M OFFICE/OP NEW PATIENT
99201
E/M INIT BRIEF FP VS/CNM FP CL
99201
E/M OFFICE/OP NEW PATIENT CNM
99201
E/M OFFICE/OP NEW PATIENT
99201
E/M OFFICE/OP NEW PATIENT
99202
E/M FP VISIT,NEW PATIENT FP CL
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99202
E/M INITIAL VS BY CNM IN FP CL
ALWAYS FAMILY PLANNING
F
99202
E/M FP VISIT,NEW PATIENT FP CL
B
99202
E/M OFFICE/OP NEW PATIENT
99202
E/M INITIAL VS BY CNM IN FP CL
99202
E/M OFFICE/OP NEW PATIENT CNM
99202
E/M OFFICE/OP NEW PATIENT
99202
E/M OFFICE/OP NEW PATIENT
99203
E/M INITIAL FP VS IN FP CLINIC
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99203
E/M INIT FP VS/CNM IN FP CL
ALWAYS FAMILY PLANNING
F
99203
E/M INITIAL FP VS IN FP CLINIC
B
99203
E/M OFFICE/OP NEW PATIENT
99203
E/M OFFICE/OP NEW PATIENT
99203
E/M INIT FP VS/CNM IN FP CL
99203
E/M OFFICE/OP NEW PATIENT CNM
99203
E/M OFFICE/OP NEW PATIENT
99203
E/M OFFICE/OP NEW PATIENT
99203
E/M OFFICE/OP NEW PATIENT
99204
E/M INITIAL FP VISIT FP CL
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99204
E/M OFFICE/OP NEW VISIT FP CL
ALWAYS FAMILY PLANNING
B
22
B B
B F F B B B
B F F B B B
F B F F B F B B
Procedure Code
Proc Layman Name
Proc AHSF Desc
Proc Valid Gender Code
99204
E/M OFFICE/OP NEW PATIENT
99204
E/M OFFICE/OP NEW PATIENT CNM
99204
E/M OFFICE/OP NEW PATIENT
99204
E/M OFFICE/OP NEW PATIENT
99205
E/M OFFICE/OP NEW IN FP CL
99205
E/M OFFICE/OP NEW PATIENT
99205
E/M OFFICE/OP NEW PATIENT
99211
E/M F/U VISIT--FP CLINIC
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99211
E/M F/U VISIT BY CNM IN FP CL
ALWAYS FAMILY PLANNING
F
99211
E/M F/U VISIT--FP CLINIC
B
99211
E/M EST PT MINIMAL PROBLEM(S)
99211
E/M F/U VISIT BY CNM IN FP CL
99211
E/M ESTAB PT- VISIT BY CNM
99211
E/M EST PT MINIMAL PROBLEM(S)
99211
E/M EST PT MINIMAL PROBLEM(S)
99212
E/M - F/U VISIT IN FP CLININC
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99212
E/M F/U FP VS BY CNM/FP CLINIC
ALWAYS FAMILY PLANNING
F
99212
E/M - FP VISIT IN FP CLINIC
B
99212
E/M OFFICE/OP - ESTABLISHED PT
99212
E/M F/U FP VS BY CNM/FP CLINIC
99212
E/M ESTABLISHED PT. VS BY CNM
99212
E/M OFFICE/OP - ESTABLISHED PT
99212
E/M OFFICE/OP - ESTABLISHED PT
99213
E/M F/U VISIT FP CLINIC
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99213
E/M F/U VISIT FP CLINIC-CNM
ALWAYS FAMILY PLANNING
F
99213
E/M F/U VISIT FP CLINIC
B
99213
E/M OFFICE/OP ESTAB PATIENT
99213
E/M OFFICE/OP ESTAB PATIENT
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
23
B F B B B B B B
B F F B B B
B F F B B B
F B
Procedure Code
Proc Layman Name
99213
E/M F/U VISIT FP CLINIC-CNM
99213
E/M ESTABLISHED PT VISIT BY CN
99213
E/M OFFICE/OP ESTAB PATIENT
99213
E/M OFFICE/OP ESTAB PATIENT
99213
E/M OFFICE/OP ESTAB PATIENT
99214 99214
Proc AHSF Desc
Proc Valid Gender Code F
E/M FOLLOW UP VISIT-FP CLINIC
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
E/M FP VISIT BY CNM-FP CLINIC
ALWAYS FAMILY PLANNING
F
99214
E/M FOLLOW UP VISIT-FP CLINIC
B
99214
E/M OFFICE/OP ESTABLISHED PT
99214
E/M FP VISIT BY CNM-FP CLINIC
99214
E/M FOLLOW UP VS EST PT BY CNM
99214
E/M OFFICE/OP ESTABLISHED PT
99214
E/M OFFICE/OP ESTABLISHED PT
99215
E/M FU VISIT IN FP CL
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99215
E/M FP VISIT BY CNM IN FP CL
ALWAYS FAMILY PLANNING
F
99215
E/M FP VISIT-ESTAB PT IN FP CL
ALWAYS FAMILY PLANNING
B
99215
E/M FP VISIT BY CNM IN FP CL
F
99215
E/M VISIT-ESTSB PT-BY CNM
99215
E/M OFFICE/OP ESTAB PT VISIT
99215
E/M OFFICE/OP ESTAB PT VISIT
99221
E/M INITIAL HOSPITAL CARE
99221
E/M INITIAL HOSPITAL CARE CNM
99221
E/M INITIAL HOSPITAL CARE
99222
E/M INITIAL HOSPITAL CARE
99223
E/M INITIAL HOSPITAL CARE
99231
E/M SUBSEQUENT HOSPITAL CARE
99231
E/M SUBSEQUENT HOSPITAL CARE
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
24
F B F B B
B F F B B B
F B B B F B B B B F
Procedure Code
Proc Layman Name
99231
E/M SUBSEQUENT HOSPITAL CARE
99232
E/M SUBSEQUENT HOSPITAL CARE
99232
E/M SUBSEQUENT HOSPITAL CARE
99232
E/M SUBSEQUENT HOSPITAL CARE
99233
E/M SUBSEQUENT HOSPITAL CARE
99238
HOSPITAL DISCHARGE DAY MANAGEM
99241
E/M OFFICE/OP CONSULT NEW/EST
99242
E/M OFFICE/OP CONSULT NEW/EST
99243
E/M OFFICE/OP CONSULT NEW/EST
99244
E/M OFFICE/OP CONSULT NEW/EST
99245
E/M OFFICE/OP CONSULT NEW/EST
99251
E/M/INITIAL INPATIENT CONSULT
99252
E/M INITIAL IP/NF CONSULT NEW/
99253
E/M INITIAL IP/NF CONSULT NEW/
99254
E/M INITIAL IP/NF CONSULT NEW/
99255
E/M INITIAL IP/NF CONSULT NEW/
99383
E/M INITIAL PREV MED 5-11 YRS
99384
E/M INITIAL PREV MED AGE 12-17
99384
E/M INITIAL PREV MED AGE 12-17
99385
E/M INITIAL PREV MED AGE 18-39
99385
E/M INITIAL PREV.MED.AGE18-39
99386
E/M INITIAL PREV.MED.AGES40-64
99386
E/M INITIAL PREV MED AGE 40-64
99386
E/M INITIAL PREV.MED.AGES40-64
25
Proc AHSF Desc
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING
Proc Valid Gender Code B B F B B B B B B B B B B B B B B F B F B B F B
Procedure Code
Proc Layman Name
Proc AHSF Desc
Proc Valid Gender Code
99387
E/M INITIAL PREV.MED.AGES 65 +
99387
E/M INITIAL PREV MED AGE 65 +
99387
E/M INITIAL PREV.MED.AGES 65 +
99393
E/M EST.PT. PREV.MED. AGES5-11
99394
E/M EST.PT.PREV.MED BY CNM
99394
E/M EST.PT.PREV.MED AGES12-17
99395
E/M PERIODIC EVAL EST PT
SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
99395
E/M PERIODIC EVAL EST. PATIENT
ALWAYS FAMILY PLANNING
F
99395
E/M PERIODIC EVALUATION EST PT
B
99395
E/M EST PT PREV MED AGE 18-39
99395
E/M PERIODIC EVAL IN FPCL CNM
99395
E/M EST.PT. PREV.MED. CNM
99395
E/M EST.PT. PREV.MED. AGE18-39
99396
E/M EST.PT. PREV.MED. CNM
99396
E/M EST.PT. PREV.MED. AGE40-64
99397
E/M EST.PT. PREV.MED. AGES65 +
99397
E/M EST.PT. PREV.MED. CNM
99397
E/M EST.PT. PREV.MED. AGE65 +
J0696
CEFTRIAXONE INJECTION 250 MG
J0696
CEFTRIAXONE INJECTION 250 MG
J1055
MEDROXYPROGESTERONE INJ 150MG
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
J1056
INJ,MEDROXYPROGESTERONE ACE/ES
ALWAYS FAMILY PLANNING
F
J1056
INJ,MEDROXYPROGESTERONE ACE/ES
ALWAYS FAMILY PLANNING
F
J3490
DRUGS UNCLASSIFIED INJECTION
ALWAYS FAMILY PLANNING
F
J7300
INTRAUT COPPER CONTRACEPTIVE
ALWAYS FAMILY PLANNING
F
J7302
LEVONORGESTREL-RELEASE IUD 52M
ALWAYS FAMILY PLANNING
F
J7303
CONTRACEPTIVE VAGINAL RING
ALWAYS FAMILY PLANNING
F
J7303
CONTRACEPTIVE VAGINAL RING
ALWAYS FAMILY PLANNING
F
J7304
CONTRACEPTIVE HORMONE PATCH
ALWAYS FAMILY PLANNING
F
26
B F B B F B B
B F F B F B B F B B B B
Procedure Code
Proc Layman Name
Proc AHSF Desc
Proc Valid Gender Code
J7304
CONTRACEPTIVE HORMONE PATCH
ALWAYS FAMILY PLANNING
F
J7307
ETONOGESTREL IMPLANT SYSTEM
ALWAYS FAMILY PLANNING
F
Q0111
WET MOUNT,PREP OF VAG.CERV.SK
F
Q0111
WET MOUNT,PREP OF VAG.CERV.SK
W9840
MEDICAL ENCOUNTER
Y7633
TEEN-DIRECTED FP SVCS INIT/YR
ALWAYS FAMILY PLANNING SOMETIMES FAMILY PLANNING SOMETIMES FAMILY PLANNING ALWAYS FAMILY PLANNING
Y7634
TEEN-DIRECTED FP SERVICE-F/U
ALWAYS FAMILY PLANNING
B
Z4334
PLAN B CONTRACEPTIVE KIT
ALWAYS FAMILY PLANNING
F
Source: NJ Medicaid Management Information System (MMIS) reference sub-system
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F B B
References i
NJ Department of Health and Senior Services, NJ Family Planning League. (2008). Family Planning Data Combined. ii Guttmacher Institute. (2006). Contraception Counts. Retrieved from: http://www.guttmacher.org/pubs/state_data/states/new_jersey.pdf iii
Ibid. iv Ibid. v NJ Department of Health and Senior Services, New Jersey Health Statistics, 2004. Retrieved from: http://www.state.nj.us/health/chs/stats04/natality.shtml vi Guttmacher Institute. (2006) vii ACOG and AAP. Guidelines for Perinatal Care, Sixth Edition, p.2. viii DS Feig, A. Razzaq, K. Syclora, J. Hux. GM Anderson. “Trends in Deliveries, Prenatal Care and Obstetrical Complications in Women with Pregestational Diabetes”. Diabetes Care; 2006; 29 (2); 232-235. ix U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Unintended Pregnancy Prevention x J. Edwards, J. Bronstein, and K. Adams, Evaluation of Medicaid Family Planning Demonstrations (The CAN Corporation, Nov. 2003), CMS Contract No. 752-2-415921:21. xi J.P. Mayer, “Unintended Childbearing, Maternal Beliefs, and Delay of Prenatal Care,” Birth 24, no.4 (1997). xii D. Belnap, (2008). Health Outcomes and Lower Costs Associated with Medicaid Family Planning Waivers. State Health Policy Briefing. xiii Ibid. xiv K. Kost et al., “The Effects of Pregnancy Planning Status on Birth Outcomes and Infant Care,” Family Planning Perspective 30, no. 5 (1998): 223-230. xv The National Campaign. Unplanned Pregnancy: Consequences of Unplanned Pregnancy Fact Sheet. xvi Center for Reproductive Rights. (2008). Title X Family Planning. Retrieved from: http://www.reproductiverights.org/pub_fac_titlex2.html xvii Guttmacher Institute. (2006) xviii New Jersey Primary Care Association. (2009). Description of Federally Funded/Qualified Health and Migrant Centers (FQHCs). Retrieved from: http://www.njpca.org/FQHC/default.aspx xix Iowa Department of Human Services. (2006). Family Planning. Retrieved from: http://www.cms.hhs.gov/MedicaidStWaivProgDemoPGI/MWDL/itemdeta il.asp?filterType=dual,%20keyword&filterValue=family%20planning&fil terByDID=0&sortByDID=2&sortOrder=ascending&itemID=CMS028636 &intNumPerPage=10 xx Ibid.
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