N.J. Admin. Code § 10:66-2.5

Current through Register Vol. 56, No. 11, June 3, 2024

Section 10:66-2.5 - Family planning services

(a) Family planning services include medical history and physical examination (including pelvis and breast), diagnostic and laboratory tests, drugs and biologicals, medical supplies and devices, counseling, continued medical supervision, continuity of care, and genetic counseling. Services provided primarily for the diagnosis and treatment of infertility, including sterilization reversals, and related clinic visits, drugs, laboratory services, radiological and diagnostic services, and surgical procedures are not covered by the New Jersey Medicaid or NJ FamilyCare fee-for-service program.

1. Exception: When a service is provided that is ordinarily considered an infertility service, but is provided for another purpose, then the independent clinic must submit the claim with supporting documentation for medical review and approval of payment to the Division of Medical Assistance and Health Services, Office of Utilization Management, PO Box 712, (Mail Code #14), Trenton, New Jersey 08625-0712.

(b) Subdermal contraceptive implants are a Medicaid-covered and NJ FamilyCare fee-for-service-covered service when provided as follows:

1. Subdermal contraceptive implants are used only in reproductive age women with established regular menstrual cycles;

2. The Food and Drug Administration-approved physician prescribing information is followed; and

3. Patient education and counseling are provided relating to subdermal contraceptive implants, including pre- and post-insertion instructions, indications, contraindications, benefits, risks, side effects, and other contraceptive modalities.

4. A clinic visit relating only to the insertion or removal of the subdermal contraceptive implants is not reimbursable on the day of the insertion or removal.

5. Only two insertions and two removals of subdermal contraceptive implants per beneficiary are permitted during the FDA-approved clinically appropriate timeframe for the specific device.

6. The clinic shall not be reimbursed for subdermal contraceptive implants in conjunction with other forms of contraception, for example, intra-uterine device.

N.J. Admin. Code § 10:66-2.5

Amended by 49 N.J.R. 1405(a), effective 6/5/2017