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Billing guidelines for coverage of intrauterine devices (IUDs)

December 6, 2018

Intrauterine devices (IUDs) are a form of long-term contraception used to prevent pregnancy. Certain IUDs have non-contraceptive uses, for example in the treatment of medical conditions that result in heavy menstrual bleeding.  

The Affordable Care Act (ACA) requires that IUDs used for contraceptive purposes be covered as a preventive service by healthcare plans. The devices are eligible for coverage under plans that offer contraceptive coverage/family planning benefits with no cost-share.

Independence coverage policies are consistent with the requirements of the ACA. The appropriate procedure and diagnosis codes must be reported to distinguish when IUDs are used for contraceptive purposes rather than non-contraceptive treatment of medical conditions.

Providers should use the Eligibility and Benefits Inquiry transaction on the NaviNet® web portal to confirm individual member benefits. Please refer to the table below for details on coverage positions and billing guidelines for IUDs that may be used for contraceptive and non-contraceptive indications.

IUDHCPCS codesIs this covered for contraceptive use?Is this covered for non-contraceptive* use?
Kyleena?J7296Yes

This is covered for contraceptive use with zero cost-share to the member as a preventive service when billed with the following ICD-10 diagnosis codes: Z01.411, Z01.419, Z30.011, Z30.012, Z30.013, Z30.014, Z30.015, Z30.016, Z30.017, Z30.018, Z30.019, Z30.02, Z30.09, Z30.2, Z30.40, Z30.41, Z30.42, Z30.430, Z30.431, Z30.432, Z30.433, Z30.44, Z30.45, Z30.46, Z30.49, Z30.8, and Z30.9.

No

This is considered experimental/investigational and therefore is not covered for non-contraceptive use.

Liletta?J7297Yes

This is covered for contraceptive use with zero cost-share to the member as a preventive service when billed with the following ICD-10 diagnosis codes: Z01.411, Z01.419, Z30.011, Z30.012, Z30.013, Z30.014, Z30.015, Z30.016, Z30.017, Z30.018, Z30.019, Z30.02, Z30.09, Z30.2, Z30.40, Z30.41, Z30.42, Z30.430, Z30.431, Z30.432, Z30.433, Z30.44, Z30.45, Z30.46, Z30.49, Z30.8, and Z30.9.

No

This is considered experimental/investigational and therefore is not covered for non-contraceptive use.

Mirena?J7298Yes

This is covered for contraceptive use with zero cost-share to the member as a preventive service when billed without the following ICD-10 diagnosis codes: N92.0, N92.1, N92.4, and Z79.890.

Yes

Mirena is covered for non-contraceptive use and will be subjected to a cost-share based on the member?s benefits when billed with the following ICD-10 diagnosis codes: N92.0, N92.1, N92.4, and Z79.890.

Skyla?J7301Yes

This is covered for contraceptive use with zero cost-share to the member as a preventive service when billed with the following ICD-10 diagnosis codes: Z01.411, Z01.419, Z30.011, Z30.012, Z30.013, Z30.014, Z30.015, Z30.016, Z30.017, Z30.018, Z30.019, Z30.02, Z30.09, Z30.2, Z30.40, Z30.41, Z30.42, Z30.430, Z30.431, Z30.432, Z30.433, Z30.44, Z30.45, Z30.46, Z30.49, Z30.8, and Z30.9.

No

This is considered experimental/investigational and therefore is not covered for non-contraceptive use.

*Providers should confirm individual member benefits using the Eligibility and Benefits Inquiry transaction on NaviNet.

Learn more

For more information, refer to the following Independence medical policies:

Commercial

  • #07.10.05k: Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
  • #00.06.02w: Preventive Care Services

Medicare Advantage

  • #MA07.025d: Intrauterine Systems (IUSs) (e.g., Mirena®, Skyla®, Liletta®, Kyleena®)
  • #MA00.003i: Preventive Care Services

To view these policies, visit our Medical Policy Portal, select Accept and Go to Medical Policy Online, then select Commercial or Medicare Advantage, depending on which version of the policy you would like to view, and then type the policy name or number in the Search field.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.


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