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Claims Erroneously Denied for Contraceptive Implant and Intrauterine Devices

September 4, 2019

The Department of Health Care Services (DHCS) has identified a claims processing issue causing Medi-Cal and Family Planning, Access, Care and Treatment (Family PACT) programs claims to be erroneously denied with Remittance Advice Details (RAD) codes 0082: Service exceeds maximum allowed by Medi-Cal policy and 0621: The monthly/yearly limit for this procedure has been exceeded. The claim is denied for the following HCPCS codes:

  HCPCS Code Description
  J7297 Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg
  J7298 Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg
  J7307 Etonogestrel (contraceptive) implant system, including implant and supplies

No action is required of providers. DHCS and the California Medicaid Management Information System Fiscal Intermediary are working to resolve this issue. Providers should continue to submit claims in a timely manner and are encouraged to check the Medi-Cal website regularly for updates regarding this issue.