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  #1  
Old 12-04-2008, 11:35 AM
barbacasec barbacasec is offline
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Default Implanon Codes

Does anyone know which CPT codes are supposed to be used for the insertion and removal of the new Implanon device? I have two different providers and they both have different ideas on which ones should be used. Dr 1 says 11981, 11982 and 11983
Dr 2 says 11975,11976, and 11977

they both make sense - is one better than the other?

thanks
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  #2  
Old 12-04-2008, 02:02 PM
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amjordan amjordan is offline
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I would go with the 11975 - 11977 because it is for contraception. The information below can be found in the 2002 CPT Changes book.

11981 “Insertion, non-biodegradable drug delivery implant”
would not be the appropriate code to use for the insertion of
contraceptives. Code 11975 “Insertion, implantable contraceptive
capsules” directly relates to contraceptives and is the
correct code to use.


Hope this information helps.
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Old 01-13-2011, 11:08 AM
tcruz tcruz is offline
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Default Implanon and Medicare

I am having a difficult time with billing Implanon to medicare. I have used 11981,J7307 with dx V25.5 and this is denying. I am at a total loss because I have no clue what I am doing wrong. Can you or anyone offer any advice? I have tried researching the CMS website and still nothing......

The denial reason states that;
N56: Procedure code billed is not correct/valid for the services billed or the date of service billed;
These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.

But this was the only thing done during the visit! I have called them and I don't get anywhere.


Last edited by tcruz; 01-13-2011 at 11:13 AM. Reason: additional information to clarify my question
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Old 01-20-2011, 07:21 AM
tammy cutler tammy cutler is offline
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Medicare will not pay for contraception.
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Old 02-11-2011, 09:58 AM
klacross klacross is offline
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We also have the same problem with the denial code that Medicare gives us. We can not bill the patient's secondary (Mass Health) because they will not accept this denial code from Medicare and we are stuck in the middle. Have you received any suggestions yet that work?
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Old 04-20-2012, 11:00 AM
Hite Hite is offline
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Default implanon J7307 Medicare

Does anyone have any additional suggestions?

Last edited by Hite; 04-20-2012 at 11:33 AM.
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Old 04-20-2012, 12:05 PM
Leandra Leandra is offline
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FYI - 11975 is a deleted code. We use 11981 for the insertion of Implanon and have no problem getting it paid.

I am not sure about the Medicare issue. Can you bill Medicare for denial to get a "proper denial" that the 2nd insurance will accept in order to process the claim for payment? When I worked in home infusion we had to bill Medicare for denial quite often for our IVIG patients.
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Old 04-20-2012, 02:15 PM
Bready Bready is offline
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11976 and 11981 are the correct codes for 2012 (and are to be used together when removing and reinserting) and are allowed by Medicare.
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Old 04-26-2012, 09:51 AM
cmiller35620 cmiller35620 is offline
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I have been billing V25.5 as the diagnosis for the Implanon and now Tricare states that the diagnosis is inconsistent with the procedure. Any suggestions?
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  #10  
Old 04-27-2012, 09:26 AM
Bready Bready is offline
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In 2012 CPT 11975 was dropped. The correct code to use for Implanon is now 11981.
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

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