MedicaidCoverageMedium impact
Newsletter Vol. 28, No.18
New Jersey Medicaid·NJ · OB-GYN·Medical Policy
Effective date
Jul 1, 2018
We identified it
Jun 20, 2026
Summary
NJ FamilyCare (NJFC/Medicaid) now covers Long-Acting Reversible Contraceptive (LARC) device insertion in the inpatient hospital setting immediately postpartum (within 10 minutes after delivery). Physicians must bill for both the LARC product and insertion procedure using specific CPT and HCPCS codes. LARC product reimbursement is capped at Wholesale Acquisition Cost (WAC) minus 1% or physician's charge, whichever is less.
Action Required
Effective July 1, 2018: Billing team must update system and encounter forms to reflect NJFC coverage of inpatient postpartum LARC insertion. (1) Configure billing software to accept CPT 58300 (IUD insertion) or 11981 (implant insertion) paired with HCPCS J7296, J7297, J7298, J7300, J7301, or J7307 for NJFC claims with inpatient hospital setting modifiers. (2) Update fee schedules to apply NJFC maximum allowances per product (Kyleena $899.88, Liletta $677.54, Mirena $899.88, ParaGard $800.42, Skyla $749.30, Nexplanon $881.40). (3) Require CMS-1500 or 837P claim submission format for all inpatient LARC procedures. (4) Ensure providers document patient's signed consent for postpartum LARC insertion within encounter notes. (5) Notify ob-gyn and hospital providers of new coverage and correct billing procedures to prevent claim delays or denials.