Contraceptive management refers to the use of reversible methods of contraception such as contraceptive devices, implants, medications, injections, and related services (e.g., insertion/removal of an implant or IUD) for the prevention of pregnancy. Services related to contraceptive management are determined according to specific individual or group customer benefits. When the member does not have coverage for the contraceptive device, implant, medication, injection, or related service, a participating, preferred or network provider can bill the member for the non-covered service.

There are some instances where a contraceptive device, implant, medication or injection may be used to treat a medical condition, (e.g., Depo-Provera for treatment of endometriosis, or an IUD for treatment of menorrhagia). When provided for treatment of medical conditions, and not solely for contraceptive purposes, contraceptive devices, implants, medications, injections and related services are covered in accordance with the member’s contractual benefits.

When a benefit, coverage for contraceptive devices, implants, medications, injections, and related services for non-contraceptive uses (i.e., medical uses) will be limited to those medical conditions listed in the "Diagnosis Codes" section.

When contraceptive devices, implants, medications, injections and related services are provided for medical conditions other than those listed in the "Diagnosis Codes" section of this policy, a participating, preferred, or network provider can bill the member for the non-covered service.

Description

Contraceptive management refers to the use of reversible methods of contraception such as contraceptive devices, implants, medications, injections, and related services (e.g., insertion/removal of an implant or IUD) for the prevention of pregnancy. 

Sterilization and abortion procedures are not considered to be contraceptive management services.

This medical policy may not apply to FEP. Medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the Federal Employee Program.