CurrentAlaska MedicaidPolicy N/A

State Fiscal Year 2027 Fee Schedule — Family Planning Services

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This document is Alaska Medicaid's fee schedule for State Fiscal Year 2027 (effective 07/01/2026–06/30/2027) specifying reimbursement base rates and NDC/medical justification flags for family planning-related CPT/HCPCS/J-codes and office visits; it affects providers billing Alaska Medicaid for those services.

Policy Summary

PayerAlaska Medicaid

PolicyState Fiscal Year 2027 Fee Schedule — Family Planning Services

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJul 1, 2026

Last ReviewJul 31, 2026

Next Review DateN/A

Key ActionReimbursement will follow the CHP encounter rate established by the Office of Rate Review and communicated to Tribal Health Organizations and participating CHA/BHAs.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

7/1/2026-6/30/2027fee schedule date range

>40 codeslisted procedures and codes

SomeJ-codes with NDC pricing

07/31/2026last revision date

Reimbursement Conditions and Documentation

Reimbursement conditions and required documentation flags

Billing and payment conditions, documentation flags, and NDC submission requirements for listed family planning procedure and drug codes.

ALL of the following

Procedure-level medical justification required
- CPT 58661 (Laparoscopy remove adnexa) — Requires Medical Justification = Y
- CPT 58700 (Removal of fallopian tube) — Requires Medical Justification = Y
NDC required (must submit NDC) for drug lines
- J1050 (Medroxyprogesterone acetate) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J1726 (Makena, 10 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J1729 (Injectable hydroxyprogesterone caproate) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7296 (Kyleena, 19.5 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7297 (Liletta, 52 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7298 (Mirena, 52 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7300 (Paragard) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7301 (Skyla, 13.5 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7307 (Etonogestrel implant system) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
Codes priced by submitted NDC (pricing determined by NDC)
- J1050, J1726, J1729, J7296–J7298, J7300–J7301, J7307 — Physician and Non‑Physician base rate listed as 'Pricing by NDC' (reimbursement determined by the submitted NDC)
ALL of the following
- Other listed procedures (no medical justification or NDC flag indicated)
  - CPT 11976 (Remove contraceptive capsule) — Requires Medical Justification = no flag; NDC Required = no flag; Physician Base Rate $245.50; Non‑Physician Base Rate $208.67
  - CPT 11981 (Insertion drug delivery implant) — Requires Medical Justification = no flag; NDC Required = no flag; Physician Base Rate $176.95; Non‑Physician Base Rate $150.40
  - CPT 58300 (Insert intrauterine device) — Requires Medical Justification = no flag; NDC Required = no flag; Physician Base Rate $179.04; Non‑Physician Base Rate $152.18
  - CPT 58301 (Remove intrauterine device) — Requires Medical Justification = no flag; NDC Required = no flag; Physician Base Rate $185.52; Non‑Physician Base Rate $157.69
  - A4267 (Male condom) — Requires Medical Justification = no flag; NDC Required = no flag; Base Rate $0.42

Operational note: For any J‑code lines flagged 'NDC Required = Y' or 'Pricing by NDC,' providers must submit the NDC on the claim to enable pricing and reimbursement as indicated.

Procedure, Supply, and Drug Codes

Selected family planning procedure and supply codesmixedCovered

11976	REMOVE CONTRACEPTIVE CAPSULE; Physician Base Rate $245.50; Non-Physician Base Rate $208.67
11981	INSERTION DRUG DLVR IMPLANT; Physician Base Rate $176.95; Non-Physician Base Rate $150.40
58300	INSERT INTRAUTERINE DEVICE; Physician Base Rate $179.04; Non-Physician Base Rate $152.18
58301	REMOVE INTRAUTERINE DEVICE; Physician Base Rate $185.52; Non-Physician Base Rate $157.69
58661	LAPAROSCOPY REMOVE ADNEXA; Physician Base Rate $1,042.42; Non-Physician Base Rate $886.06; Requires Medical Justification = Y
58700	REMOVAL OF FALLOPIAN TUBE; Physician Base Rate $1,279.37; Non-Physician Base Rate $1,087.47; Requires Medical Justification = Y
99202	OFFICE O/P NEW SF 15 MIN; Physician Base Rate $128.60; Non-Physician Base Rate $109.31
99213	OFFICE O/P EST LOW 20 MIN; Physician Base Rate $165.33; Non-Physician Base Rate $140.53
A4267	MALE CONDOM; Physician/Non-Physician Base Rate $0.42
J1050	MEDROXYPROGESTERONE ACETATE; Pricing by NDC; NDC Required = Y

1–10 of 13

1/2

inv-03: NDC pricing requirement

ScopeSeveral J‑codes in the fee schedule are priced by NDC (pricing for the line item is determined based on the National Drug Code submitted).

Affected codes (examples)J1050, J1726, J1729, J7296–J7298, J7300–J7301, J7307 (each listed with 'Physician Base Rate = Pricing by NDC' and 'Non‑Physician Base Rate = Pricing by NDC').

NDC Required flagThese J‑codes include an explicit 'NDC Required = Y' flag in the fee schedule, indicating submission of the NDC is mandatory for reimbursement.

Rate displayFor affected J‑codes the fee schedule shows 'Physician Base Rate = Pricing by NDC' and 'Non‑Physician Base Rate = Pricing by NDC' rather than a fixed dollar amount.

Documentation implicationBecause pricing is determined by submitted NDC, providers must supply the correct NDC on claims to ensure proper adjudication and reimbursement.

Billing Mechanism and Provider Notices

Billing Rule

Reimbursement follows CHP encounter rate

Reimbursement for services on this fee schedule will follow the CHP (Community Health Program) encounter rate as established annually by the Office of Rate Review and distributed to Tribal Health Organizations and participating CHAs/BHAs.

Key Terms and Pricing Notes

inv-05: CHP encounter rate

DefinitionCHP (Community Health Program) encounter rate as used for reimbursement — the encounter rate established by the Office of Rate Review (ORR) each calendar year and distributed to Tribal Health Organizations and participating CHAs/BHAs.

ApplicabilityUsed as the reimbursement mechanism for services provided under the CHP to Tribal Health Organizations and participating CHAs/BHAs, per the fee schedule notice.

TimingORR establishes the CHP encounter rate annually and it is communicated each calendar year to the relevant organizations.

Document referenceStated in the SFY 2027 fee schedule 'Reimbursement will follow the CHP (Community Health Program) encounter rate which is established by Office of Rate Review (ORR) each calendar year and sent out to the Tribal Health Organizations (THO's) with participating CHA's and BHA's.'

inv-06: Pricing by NDC / NDC Required

Meaning'Pricing by NDC' means the fee schedule determines reimbursement for the line item based on the National Drug Code submitted on the claim rather than a fixed base dollar rate.

NDC Required flagWhen the fee schedule shows 'NDC Required = Y' for a code, submission of the NDC on the claim is mandatory for that item (e.g., J1050, J7298, J7300, J7307).

Fee schedule presentationAffected codes are listed with 'Physician Base Rate = Pricing by NDC' and 'Non‑Physician Base Rate = Pricing by NDC' in place of numeric rates.

ExamplesExamples in this schedule include J1050 (MEDROXYPROGESTERONE ACETATE), J7296–J7298 (IUD products), J7300–J7301, J7307 (implant systems) — each marked 'Pricing by NDC' and 'NDC Required = Y'.

Policy Summary

PayerAlaska Medicaid

PolicyState Fiscal Year 2027 Fee Schedule — Family Planning Services

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateJul 1, 2026

Last ReviewJul 31, 2026

Next Review DateN/A

Key ActionReimbursement will follow the CHP encounter rate established by the Office of Rate Review and communicated to Tribal Health Organizations and participating CHA/BHAs.

SourceLink

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State Fiscal Year 2027 Fee Schedule — Family Planning Services

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Sign up for all Alaska Medicaid policy alerts

Know when Alaska Medicaid releases new policies or updates existing guidance.

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Receive email alerts as soon as relevant payer policies are published or updated.

Reimbursement Conditions and Documentation

Reimbursement conditions and required documentation flags

Billing and payment conditions, documentation flags, and NDC submission requirements for listed family planning procedure and drug codes.

ALL of the following

Procedure-level medical justification required
- CPT 58661 (Laparoscopy remove adnexa) — Requires Medical Justification = Y
- CPT 58700 (Removal of fallopian tube) — Requires Medical Justification = Y
NDC required (must submit NDC) for drug lines
- J1050 (Medroxyprogesterone acetate) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J1726 (Makena, 10 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J1729 (Injectable hydroxyprogesterone caproate) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7296 (Kyleena, 19.5 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7297 (Liletta, 52 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7298 (Mirena, 52 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7300 (Paragard) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7301 (Skyla, 13.5 mg) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
- J7307 (Etonogestrel implant system) — NDC Required = Y; Physician/Non-Physician base rate: Pricing by NDC
Codes priced by submitted NDC (pricing determined by NDC)
- J1050, J1726, J1729, J7296–J7298, J7300–J7301, J7307 — Physician and Non‑Physician base rate listed as 'Pricing by NDC' (reimbursement determined by the submitted NDC)
ALL of the following
- Other listed procedures (no medical justification or NDC flag indicated)
  - CPT 11976 (Remove contraceptive capsule) — Requires Medical Justification = no flag; NDC Required = no flag; Physician Base Rate $245.50; Non‑Physician Base Rate $208.67
  - CPT 11981 (Insertion drug delivery implant) — Requires Medical Justification = no flag; NDC Required = no flag; Physician Base Rate $176.95; Non‑Physician Base Rate $150.40
  - CPT 58300 (Insert intrauterine device) — Requires Medical Justification = no flag; NDC Required = no flag; Physician Base Rate $179.04; Non‑Physician Base Rate $152.18
  - CPT 58301 (Remove intrauterine device) — Requires Medical Justification = no flag; NDC Required = no flag; Physician Base Rate $185.52; Non‑Physician Base Rate $157.69
  - A4267 (Male condom) — Requires Medical Justification = no flag; NDC Required = no flag; Base Rate $0.42

Operational note: For any J‑code lines flagged 'NDC Required = Y' or 'Pricing by NDC,' providers must submit the NDC on the claim to enable pricing and reimbursement as indicated.

Procedure, Supply, and Drug Codes

Selected family planning procedure and supply codesmixedCovered

11976	REMOVE CONTRACEPTIVE CAPSULE; Physician Base Rate $245.50; Non-Physician Base Rate $208.67
11981	INSERTION DRUG DLVR IMPLANT; Physician Base Rate $176.95; Non-Physician Base Rate $150.40
58300	INSERT INTRAUTERINE DEVICE; Physician Base Rate $179.04; Non-Physician Base Rate $152.18
58301	REMOVE INTRAUTERINE DEVICE; Physician Base Rate $185.52; Non-Physician Base Rate $157.69
58661	LAPAROSCOPY REMOVE ADNEXA; Physician Base Rate $1,042.42; Non-Physician Base Rate $886.06; Requires Medical Justification = Y
58700	REMOVAL OF FALLOPIAN TUBE; Physician Base Rate $1,279.37; Non-Physician Base Rate $1,087.47; Requires Medical Justification = Y
99202	OFFICE O/P NEW SF 15 MIN; Physician Base Rate $128.60; Non-Physician Base Rate $109.31
99213	OFFICE O/P EST LOW 20 MIN; Physician Base Rate $165.33; Non-Physician Base Rate $140.53
A4267	MALE CONDOM; Physician/Non-Physician Base Rate $0.42
J1050	MEDROXYPROGESTERONE ACETATE; Pricing by NDC; NDC Required = Y

1–10 of 13

1/2

inv-03: NDC pricing requirement

ScopeSeveral J‑codes in the fee schedule are priced by NDC (pricing for the line item is determined based on the National Drug Code submitted).

Affected codes (examples)J1050, J1726, J1729, J7296–J7298, J7300–J7301, J7307 (each listed with 'Physician Base Rate = Pricing by NDC' and 'Non‑Physician Base Rate = Pricing by NDC').

NDC Required flagThese J‑codes include an explicit 'NDC Required = Y' flag in the fee schedule, indicating submission of the NDC is mandatory for reimbursement.

Rate displayFor affected J‑codes the fee schedule shows 'Physician Base Rate = Pricing by NDC' and 'Non‑Physician Base Rate = Pricing by NDC' rather than a fixed dollar amount.

Documentation implicationBecause pricing is determined by submitted NDC, providers must supply the correct NDC on claims to ensure proper adjudication and reimbursement.

Key Terms and Pricing Notes

inv-05: CHP encounter rate

ApplicabilityUsed as the reimbursement mechanism for services provided under the CHP to Tribal Health Organizations and participating CHAs/BHAs, per the fee schedule notice.

TimingORR establishes the CHP encounter rate annually and it is communicated each calendar year to the relevant organizations.

inv-06: Pricing by NDC / NDC Required

Meaning'Pricing by NDC' means the fee schedule determines reimbursement for the line item based on the National Drug Code submitted on the claim rather than a fixed base dollar rate.

NDC Required flagWhen the fee schedule shows 'NDC Required = Y' for a code, submission of the NDC on the claim is mandatory for that item (e.g., J1050, J7298, J7300, J7307).

Fee schedule presentationAffected codes are listed with 'Physician Base Rate = Pricing by NDC' and 'Non‑Physician Base Rate = Pricing by NDC' in place of numeric rates.