The Family Planning Services is identified in Kentucky Medicaid as Provider Type (32) entity and may bill Kentucky Medicaid using this provider type number. In order for a Family Planning Service entity to provide services to a Medicaid beneficiary, it must:
- have an administrative director; one physician or physician assistant; one R.N.
- be enrolled as a Kentucky Medicaid provider
- be enrolled with the Managed Care Organization (MCO) of any beneficiary it wishes to treat.
What are Family Planning Services? Family Planning includes complete medical history, physical examination, laboratory and clinical test supplies, educational material, counseling and prescribed birth control methods to best suit the beneficiaries needs. Additional medical services are available through referral to private physicians.
Family Planning Services entities must meet the coverage provisions and requirements set forth in
907 KAR 1:048 in order to provide covered services. All services must be performed within the scope of practice for any provider. Just because a service is listed in the administrative regulation does not guarantee payment of the service. Providers must follow the regulations and must follow requirements of the MCO for which they participate. All services must be medically necessary.
Reimbursement: Reimbursement in accordance with the flat fee schedule shall be at the following rates:
|Services provided by a Physician |||
Initial Clinic visit
Annual clinic visit
Follow-up visit with pelvic exam
|Follow-up visit w/o pelvic exam||$20.00|
|Services provided by PA/ APRN with appropriate training|||
Initial Clinic visit
Annual clinic visit
Follow-up visit with pelvic examination
Follow-up visit w/o pelvic examination
Counseling visit with 3 month contraceptive supply
Counseling visit with 6 month contraceptive supply
|Supply Only Visit||Cost|
(The supply only visit fee shall not be paid as
an addition to a fee for another type of visit, since the fee for other types
of visits includes an amount for contraceptives.)
Multiple Services: Multiple services on the same patient at the
same session shall not be reimbursed. Family Planning Services are
limited to one service per date of service. More than one clinic visit is
not allowed on the same day. Anything considered incidental shall not be
covered by Kentucky Medicaid.
Some services may require prior authorization. Family Planning Services requiring prior authorization must contact
Kentucky Medicaid currently contracts with
DXC to process Medicaid claims. (Each MCO contracts with their own billing agent.)
Kentucky Medicaid utilizes National Correct Coding Initiative (NCCI) edits as well as the McKesson Claim Check System to verify codes that are mutually exclusive or incidental.
Coding: Kentucky Medicaid uses Correct Procedural Terminology (CPT) codes and Healthcare Common Procedure Coding system (HCPCS) codes. Kentucky Medicaid requires the use of ICD-10 codes on all claims submitted for reimbursement. (eff: 10/1/15) Kentucky Medicaid requires the use of CMS 1500 billing forms. (eff: 02/12)
Claim Appeals: Appeal requests made on denied claims must be submitted to
DXC. The request must include the reason of the request along with a hard copy claim.
Timely Filing: Claims must be received within 12 months from the date of service (DOS) or 6 months from the Medicare pay date whichever is longer, or within 12 months from the last Kentucky Medicaid denial.
Provider Contact Information
If you can't find the information you need or have additional questions, please direct your inquiries to:
Billing Questions -
DXC - (800) 807-1232
Provider Questions - (855) 824-5615
Prior Authorization -
CareWise - (800) 292-2392
Provider Enrollment or Recertification - (877) 838-5085
KyHealth.net assistance -
DXC - (800) 205-4696
Pharmacy Questions - (800) 432-7005
Pharmacy Clinical Support Questions - (800) 477-3071
Pharmacy Prior Authorization - (800) 477-3071
Physician Administered Drug (PAD) List - Pharmacy Branch - (502) 564-6890