Claims Processing for IUDs, Mirena and Other Contraceptive Devices

Attention OB-GYN providers:

Please be advised that claims for the insertion and removal of IUDs, Mirena and other contraceptive devices are to adhere to the following rules:

  • All claims/invoices are to be accompanied by a CMS 1500 or UB04 form or they will be denied.
  • The HCPCS code to bill for the IUD Mirena is J7298.

For all other IUDs and covered contraceptive devices, Horizon NJ Health will provide payment as follows:

  • 85 percent of the AWP (average wholesale price) of the attached invoice.
  • Reimbursements for this code will not exceed the plan maximum.

Thank you for your cooperation.

Published on: September 30, 2014, 23:39 PM ET
Last updated on: October 17, 2018, 02:24 AM ET