DHCS APL 22-011 – Prop 56 Directed Payments for Family Planning Services
DHCS provided updated guidance on directed payments, funded by the California Healthcare, Research and Prevention Tobacco Tax Act of 2016 (Proposition 56), for the provision of specified family planning services with dates of service on or after July 1, 2019.
The Alliance will continue to pay qualified contracted and non-contracted providers a uniform and fixed dollar add-on amount for the specified family planning services (listed below) provided to a Medi-Cal managed care member who is not dually eligible for Medi-Cal and Medicare Part B (regardless of enrollment in Medicare Part A or Part D) with dates of service on or after July 1, 2019, in accordance with the CMS-approved preprint for this program, which will be made available on DHCS’ Directed Payments Program website upon CMS approval.
The uniform dollar add-on amounts of the directed payments vary by procedure code:
| Procedure Code | Description | Uniform Dollar Add- on Amount | Dates of Service |
| J7294 | CONTRACEPTIVE VAGINAL RING: SEGESTERONE ACETATE AND ETHINYL ESTRADIOL | $301.00 | 1/1/2022 – Ongoing |
| J7295 | CONTRACEPTIVE VAGINAL RING: ETHINYL ESTRADIOL AND ETONOGESTREL | $301.00 | 1/1/2022 – Ongoing |
| J7296 | LEVONORGESTREL-RELEASING IU COC SYS 19.5 MG | $2,727.00 | 7/1/2019 – Ongoing |
| J7297 | LEVONORGESTREL-RLS INTRAUTERINE COC SYS 52 MG | $2,053.00 | 7/1/2019 – Ongoing |
| J7298 | LEVONORGESTREL-RLS INTRAUTERINE COC SYS 52 MG | $2,727.00 | 7/1/2019 – Ongoing |
| J7300 | INTRAUTERINE COPPER CONTRACEPTIVE | $2,426.00 | 7/1/2019 – Ongoing |
| J7301 | LEVONORGESTREL-RLS INTRAUTERINE COC SYS 13.5 MG | $2,271.00 | 7/1/2019 – Ongoing |
| J7303 | CONTRACEPTIVE VAGINAL RING | $301.00 | 7/1/2019 – 12/31/2021 |
| J7304 | CONTRACEPTIVE PATCH | $110.00 | 7/1/2019 – 12/31/2021 |
| J7304U1 | CONTRACEPTIVE PATCH: NORELGESTROMIN AND ETHINYL ESTRADIOL | $110.00 | 1/1/2022 – Ongoing |
| J7304U2 | CONTRACEPTIVE PATCH: LEVONORGESTREL AND ETHINYL ESTRADIOL | $110.00 | 1/1/2022 – Ongoing |
| J7307 | ETONOGESTREL CNTRACPT IMPL SYS INCL IMPL & SPL | $2,671.00 | 7/1/2019 – Ongoing |
| J3490U5 | EMERG CONTRACEPTION: ULIPRISTAL ACETATE 30 MG | $72.00 | 7/1/2019 – Ongoing |
| J3490U6 | EMERG CONTRACEPTION: LEVONORGESTREL 0.75 MG (2) & 1.5 MG (1) | $50.00 | 7/1/2019 – Ongoing |
| J3490U8 | DEPO-PROVERA | $340.00 | 7/1/2019 – Ongoing |
| 11976 | REMOVE CONTRACEPTIVE CAPSULE | $399.00 | 7/1/2019 – Ongoing |
| 11981 | INSERT DRUG IMPLANT DEVICE | $835.00 | 7/1/2019 – Ongoing |
| 58300 | INSERT INTRAUTERINE DEVICE | $673.00 | 7/1/2019 – Ongoing |
| 58301 | REMOVE INTRAUTERINE DEVICE | $195.00 | 7/1/2019 – Ongoing |
| 55250 | REMOVAL OF SPERM DUCT(S) | $521.00 | 7/1/2019 – Ongoing |
| 58340 | CATHETER FOR HYSTEROGRAPHY | $371.00 | 7/1/2019 – Ongoing |
| 58555 | HYSTEROSCOPY DX SEP PROC | $322.00 | 7/1/2019 – 12/31/2019 |
| 58565 | HYSTEROSCOPY STERILIZATION | $1,476.00 | 7/1/2019 – 12/31/2019 |
| 58600 | DIVISION OF FALLOPIAN TUBE | $1,515.00 | 7/1/2019 – Ongoing |
| 58615 | OCCLUDE FALLOPIAN TUBE(S) | $1,115.00 | 7/1/2019 – Ongoing |
| 58661 | LAPAROSCOPY REMOVE ADNEXA | $978.00 | 7/1/2019 – Ongoing |
| 58670 | LAPAROSCOPY TUBAL CAUTERY | $843.00 | 7/1/2019 – Ongoing |
| 58671 | LAPAROSCOPY TUBAL BLOCK | $892.00 | 7/1/2019 – Ongoing |
| 58700 | REMOVAL OF FALLOPIAN TUBE | $1,216.00 | 7/1/2019 – Ongoing |
| 81025 | URINE PREGNANGY TEST | $6.00 | 7/1/2019 – Ongoing |
