Procedure Codes Eligible for 90% FFP When Coded in Combination With a Dx Code in the V25 Range
(see below) *
- Billing Guidance is also available in Excel Format (XLS, 52KB)
| Code | Short Description |
|---|---|
| 11975 | Insert contraceptive cap |
| 11976 | Removal of contraceptive cap |
| 11977 | Removal/reinsert contra cap |
| 55250 | Removal of sperm duct(s) |
| 55450 | Ligation of sperm duct |
| 58100 | Biopsy of uterus lining |
| 58300 | Insert intrauterine device |
| 58301 | Remove intrauterine device |
| 58340 | Catheter for hysterography |
| 58565 | Hysteroscopy sterilization |
| 58600 | Division of fallopian tube |
| 58615 | Occlude fallopian tube(s) |
| 58670 | Laparoscopy tubal cautery |
| 58671 | Laparoscopy tubal block |
| 71010 | Chest x-ray |
| 71015 | Chest x-ray |
| 71020 | Chest x-ray |
| 74000 | X-ray exam of abdomen |
| 76830 | Transvaginal us non-ob |
| 76856 | Us exam pelvic complete |
| 76857 | Us exam pelvic limited |
| 77078 | Ct bone density axial |
| 77079 | Ct bone density peripheral |
| 77080 | Dxa bone density axial |
| 77081 | Dxa bone density/peripheral |
| 77083 | Radiographic absorptiometry |
| 80048 | Metabolic panel total ca |
| 80053 | Comprehen metabolic panel |
| 80061 | Lipid panel |
| 80076 | Hepatic function panel |
| 81000 | Urinalysis nonauto w/scope |
| 81001 | Urinalysis auto w/scope |
| 81002 | Urinalysis nonauto w/o scope |
| 81003 | Urinalysis auto w/o scope |
| 81007 | Urine screen for bacteria |
| 81015 | Microscopic exam of urine |
| 81025 | Urine pregnancy test |
| 82040 | Assay of serum albumin |
| 82043 | Microalbumin quantitative |
| 82150 | Assay of amylase |
| 82247 | Bilirubin total |
| 82270 | Occult blood feces |
| 82465 | Assay bld/serum cholesterol |
| 82550 | Assay of ck (cpk) |
| 82553 | Creatine mb fraction |
| 82565 | Assay of creatinine |
| 82570 | Assay of urine creatinine |
| 82575 | Creatinine clearance test |
| 82670 | Assay of estradiol |
| 82677 | Assay of estriol |
| 82947 | Assay glucose blood quant |
| 82948 | Reagent strip/blood glucose |
| 82950 | Glucose test |
| 82951 | Glucose tolerance test (GTT) |
| 83001 | Gonadotropin (FSH) |
| 83002 | Gonadotropin (LH) |
| 83690 | Assay of lipase |
| 84075 | Assay alkaline phosphatase |
| 84144 | Assay of progesterone |
| 84146 | Assay of prolactin |
| 84443 | Assay thyroid stim hormone |
| 84703 | Chorionic gonadotropin assay |
| 85002 | Bleeding time test |
| 85004 | Automated diff wbc count |
| 85007 | Bl smear w/diff wbc count |
| 85013 | Spun microhematocrit |
| 85014 | Hematocrit |
| 85018 | Hemoglobin |
| 85025 | Complete cbc w/auto diff wbc |
| 85027 | Complete cbc automated |
| 85032 | Manual cell count each |
| 85045 | Automated reticulocyte count |
| 85049 | Automated platelet count |
| 85210 | Blood clot factor II test |
| 85300 | Antithrombin III test |
| 85378 | Fibrin degrade semiquant |
| 85576 | Blood platelet aggregation |
| 85610 | Prothrombin time |
| 85651 | Rbc sed rate nonautomated |
| 85652 | Rbc sed rate automated |
| 85730 | Thromboplastin time partial |
| 86580 | TB intradermal test |
| 86592 | Syphilis test non-trep qual |
| 86593 | Syphilis test non-trep quant |
| 86631 | Chlamydia antibody |
| 86632 | Chlamydia igm antibody |
| 86687 | Htlv-i antibody |
| 86689 | HTLV/HIV confirmatory test |
| 86696 | Herpes simplex type 2 |
| 86701 | HIV-1 |
| 86702 | HIV-2 |
| 86703 | Hiv-1/hiv-2 single assay |
| 86762 | Rubella antibody |
| 86900 | Blood typing abo |
| 86901 | Blood typing rh (d) |
| 87015 | Specimen concentration |
| 87040 | Blood culture for bacteria |
| 87070 | Culture bacteria other |
| 87075 | Cultr bacteria except blood |
| 87077 | Culture aerobic identify |
| 87081 | Culture screen only |
| 87086 | Urine culture/colony count |
| 87088 | Urine bacteria culture |
| 87102 | Fungus isolation culture |
| 87110 | Chlamydia culture |
| 87164 | Dark field examination |
| 87166 | Dark field examination |
| 87205 | Smear gram stain |
| 87206 | Smear fluorescent/acid stai |
| 87207 | Smear special stain |
| 87210 | Smear wet mount saline/ink |
| 87252 | Virus inoculation tissue |
| 87254 | Virus inoculation shell via |
| 87255 | Genet virus isolate hsv |
| 87270 | Chlamydia trachomatis ag if |
| 87273 | Herpes simplex 2 ag if |
| 87274 | Herpes simplex 1 ag if |
| 87320 | Chylmd trach ag eia |
| 87390 | Hiv-1 ag eia |
| 87486 | Chylmd pneum dna amp probe |
| 87490 | Chylmd trach dna dir probe |
| 87491 | Chylmd trach dna amp probe |
| 87495 | Cytomeg dna dir probe |
| 87535 | Hiv-1 dna amp probe |
| 87590 | N.gonorrhoeae dna dir prob |
| 87591 | N.gonorrhoeae dna amp prob |
| 87620 | Hpv dna dir probe |
| 87621 | Hpv dna amp probe |
| 87797 | Detect agent nos dna dir |
| 87800 | Detect agnt mult dna direc |
| 87801 | Detect agnt mult dna ampli |
| 87899 | Agent nos assay w/optic |
| 88141 | Cytopath c/v interpret |
| 88142 | Cytopath c/v thin layer |
| 88143 | Cytopath c/v thin layer redo |
| 88147 | Cytopath c/v automated |
| 88148 | Cytopath c/v auto rescreen |
| 88150 | Cytopath c/v manual |
| 88152 | Cytopath c/v auto redo |
| 88153 | Cytopath c/v redo |
| 88154 | Cytopath c/v select |
| 88155 | Cytopath c/v index add-on |
| 88160 | Cytopath smear other source |
| 88161 | Cytopath smear other source |
| 88162 | Cytopath smear other source |
| 88164 | Cytopath tbs c/v manual |
| 88165 | Cytopath tbs c/v redo |
| 88173 | Cytopath eval fna report |
| 88174 | Cytopath c/v auto in fluid |
| 88175 | Cytopath c/v auto fluid redo |
| 88302 | Tissue exam by pathologist |
| 88305 | Tissue exam by pathologist |
| 88307 | Tissue exam by pathologist |
| 89321 | Semen anal sperm detection |
| 93000 | Electrocardiogram complete |
| 93010 | Electrocardiogram report |
| 93040 | Rhythm ECG with report |
| 93307 | Tte w/o doppler complete |
| 99050 | Medical services after hrs |
| 99051 | Med serv eve/wkend/holiday |
| 99070 | Special supplies |
| 99201 | Office/outpatient visit new |
| 99202 | Office/outpatient visit new |
| 99203 | Office/outpatient visit new |
| 99204 | Office/outpatient visit new |
| 99205 | Office/outpatient visit new |
| 99211 | Office/outpatient visit est |
| 99212 | Office/outpatient visit est |
| 99213 | Office/outpatient visit est |
| 99214 | Office/outpatient visit est |
| 99215 | Office/outpatient visit est |
| 99241 | Office consultation |
| 99242 | Office consultation |
| 99243 | Office consultation |
| 99244 | Office consultation |
| 99245 | Office consultation |
| 99384 | Prev visit new age 12-17 |
| 99385 | Prev visit new age 18-39 |
| 99386 | Prev visit new age 40-64 |
| 99394 | Prev visit est age 12-17 |
| 99395 | Prev visit est age 18-39 |
| 99396 | Prev visit est age 40-64 |
| ∗ | This list is a subset of Family Planning procedures and only includes |
| A4266 | Diaphragm |
| A4267 | Male condom |
| A4268 | Female condom |
| A4931 | Reusable oral thermometer |
| J1055 | Medrxyprogester acetate inj |
| J1056 | MA/EC contraceptiveinjection |
| J7300 | Intraut copper contraceptive |
| J7302 | Levonorgestrel iu contracept |
| J7303 | Contraceptive vaginal ring |
| J7304 | Contraceptive hormone patch |
| J7306 | Levonorgestrel implant sys |
| J7307 | Etonogestrel implant system services that are eligible for 90% Federal financial participation |
| V25 Diagnosis - Potentially Eligible for Enhanced Medicaid Payment | |
|---|---|
| DX general format |
Description |
| V2501 | Prescrip-oral contracept |
| V2502 | Initiate contracept NEC |
| V2503 | Contracept mgmt-emergncy |
| V2504 | Natrl fam pln-avoid preg |
| V2509 | Contraceptive mangmt NEC |
| V2511 | Insertion of iud |
| V2512 | Removal of iud |
| V2513 | Remove/insert iud |
| V252 | Sterilization |
| V252 | Sterilization |
| V253 | Menstrual extraction |
| V2540 | Contracept surveill NOS |
| V2541 | Contracept pill surveill |
| V2542 | Iud surveillance |
| V2543 | Srvl mplnt sbdrm cntrcep |
| V2549 | Contracept surveill NEC |
| V255 | Nsrt mplnt sbdrm cntrcep |
| V258 | Contraceptive mangmt NEC |
| V259 | Contraceptive mangmt NOS |
