MedicaidCoverageMedium impact
Newsletter Vol. 3, No. 20
New Jersey Medicaid·NJ · OB-GYN·Provider Notice
We identified it
Jun 20, 2026
Summary
This Medicaid policy establishes reimbursement limits and billing procedures for Norplant System (levonorgestrel subdermal implant) insertion, reinsertion, and removal services in hospital outpatient departments. Key restrictions include: maximum of 2 insertions and 2 removals per 5-year period, and prohibition of concurrent billing with other contraceptive methods (e.g., IUD insertion). Hospital outpatient departments must use specific billing codes and revenue codes with cost-to-charge reimbursement methodology.
Action Required
Immediately: Billing team must implement Norplant System reimbursement restrictions in hospital outpatient department billing workflows. (1) Update billing system to enforce the 2 insertion/2 removal limit per 5-year continuous period for Medicaid claims; (2) Configure system to reject or flag claims that bill Norplant insertion/reinsertion concurrently with other contraceptive procedures (IUD insertion, etc.); (3) Ensure revenue codes and clinic codes specified in this policy are correctly mapped in billing software; (4) Train billing staff that Norplant kit charges must be included with revenue code billing; (5) Apply cost-to-charge reimbursement methodology for these services. Note: The policy document references specific clinic codes, revenue codes, and ICD-CM diagnosis codes but the actual codes are not clearly legible in the source material—obtain a clean copy from the Medical Consultant Division to complete system configuration. Failure to enforce these limits will result in Medicaid claim denials.