Billing for Codes and Services

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SoonerPlan will pay for the following services:

  • Birth control information and supplies
  • Office visits and physical exams related to family planning;
  • Laboratory tests related to family planning services, including pregnancy tests, Pap smears and screening for some sexually transmitted infections;
  • Tubal ligations for women age 21 and older;
  • Vasectomies for men age 21 and older; and
  • Gardasil for males and females through age 26.

Tubal ligations and vasectomies are paid in accordance with current SoonerCare policy and require the Sterilization Consent form.

Medically necessary office visits related to family planning are unlimited for SoonerPlan members younger than 21.

For SoonerPlan members 21 and older, medically necessary office visits and physical exams related to family planning (birth control) are limited to four per month except for the initial visit code. For 99202, the limit is two per month.

Copayments do not apply for any family planning service, device, prescription or over-the-counter product.

Billing

Claims for family planning services can be billed electronically or by using the appropriate paper claim form. You should use your

SoonerCare fee-for-service provider number when submitting these claims.

Coverage for this program is limited to the use of listed diagnosis codes. Please be advised that these diagnosis codes are subject to change. These are effective October 1, 2015. For claims billed with dates of service Oct. 1, 2015, use the new ICD-10 codes. For claims with dates of service before Oct. 1, use ICD-9 codes.

The following CPT codes are covered services under this program and are reimbursed at the current SoonerCare Fee-for-Service rate:

Please be advised that these CPT codes are subject to change.

 

Important Disclaimers:

 

Services reimbursed based on provider specific (contracted rates) or specialty based rates are not included under SoonerPlan. To inquire about other rates, please call our Customer Service provider line.

 

  • This fee schedule does not address the various coverage limitations routinely applied by SoonerPlan before final payment is determined (e.g., recipient and provider eligibility, billing instructions, frequency of services, third party liability, age restrictions, prior authorization, etc.)
  • Although every effort is made to keep the schedule accurate and current, it is not the official document of record. If you are a current Medicaid/SoonerPlan provider, you may refer to the Pricing section on our Provider Secure Site, or call our Customer Service provider line.