Provider Notice for Medicaid Family Planning Waiver Services

Retroactive to October 1, 1998, Florida Medicaid, in collaboration with the Department of Health, initiated extended Medicaid coverage for family planning services only. The new program is for women, ages 14-55, who have lost their eligibility for Florida Medicaid benefits.

Medicaid providers who participate will receive Medicaid payments for the extended family planning services. This means you can receive payments for services you may have been providing for free.

Eligible women will have access to all Medicaid-covered family planning services. In addition to all family planning-related pharmacy services, antibiotic treatment of sexually transmitted diseases will also be covered. Inpatient services are not included.

Please read the following  information to learn more about the extended family planning services program. We look forward to working with you and your staff to make this program a success for the women of Florida. If you have more questions, please call your Medicaid area office.

Questions and Answers for Providers

Q. What are Medicaid Extended Family Planning Services?

A. They are the same services covered under the regular Medicaid family planning program, with one exception. These services are only available to qualified women who lose eligibility for Medicaid.

Q. Who is eligible for these services?

A. Women, ages 14-55, who have lost Medicaid eligibility; desire family planning services; are at or below 185% of the federal poverty level; have no medical insurance; and are capable of having a child. This includes beneficiaries that have lost Medicaid HMO coverage.

Q. How do I know if a woman is eligible?

A. Medicaid Eligibility Verification Systems (MEVS), and all other methods of verifying recipient eligibility will identify these women as eligible for waiver services with an eligibility category "FP". They will not be eligible for any other Medicaid benefits.

Q. What diagnoses are covered?

A. Claims for these extended family planning service evaluation and management visits must be submitted with an appropriate family planning diagnosis code,V25.01 through V25.9. Claims for colposcopies must be submitted with 622.1,795.0, or 795.1. Claims for laboratory procedures must be submitted with one of the following:

634.0-634.9
054.0-054.9
078.0-078.19
079.88,079.98
090.3-099.9
112.0-112.9
131.0-131.9

Q. What procedures are covered?

A. Click here for the list of covered procedures. Also, refer to your provider Coverage and Limitations Handbook for more information regarding family planning services.

Q. How much do I get paid?

A. Participating providers receive the same reimbursement rates for extended family planning services as they receive for regular Medicaid family planning services.

Q. How do I sign up?

A. Since you are already enrolled as a Medicaid provider and provide family planning services to Medicaid patients, you do not need to do anything else.

Q. How do I get more information?

A. Contact your local Medicaid Area Office for more information.