Family Planning Services Information for Providers
Family planning services available to Colorado Medicaid clients:
- Office visits and counseling (preventive and problem-focused)
- Oral contraceptives (If a generic alternative exists for the prescription written, then the generic alternative will be provided unless the prescriber can provide client-specific clinical evidence that the generic alternative has failed or is not appropriate for the client.)
- Contraceptive patches and vaginal rings
- Contraceptive implants (implant, insertion, and removal)
- Intrauterine devices (IUDs – the device, insertion, and removal)
- Contraceptive injections
- Diaphragms (the device, fitting, and instruction)
- Emergency contraception (requires a prescription to be called in or written)
- Condoms (when billed by a provider’s office, not a pharmacy)
- Human papillomavirus vaccines (ages 9 to 26 – Vaccines for children 0 through 20 must be acquired from the Colorado Department of Public Health and Environment)
- Surgical sterilization for clients 21 years old or older (This includes traditional sterilization as well as hysteroscopic sterilizations). All sterilization claims will only be reimbursed if accompanied by a completed and signed MED-178 consent form.
Elective pregnancy termination is only covered when the pregnancy is the result of rape or incest, or if continuing the pregnancy would put the life of the pregnant woman in danger.
Choice of Providers:
Colorado Medicaid clients can choose to see any Medicaid provider who offers family planning services. Family planning services do not require a referral from a primary care provider regardless of the client’s Medicaid eligibility type.
Provider-purchased contraceptives (such as those obtained through the 340B Drug Pricing Program) can be reimbursed at the purchase price when billed on a medical claim.
Reimbursement Rates and Client Co-Payments:
Procedure code reimbursement rates can be found in the Colorado Medicaid Fee Schedule.