CurrentHumanaPolicy CP2024002

Long-Acting Reversible Contraception While Inpatient Postpartum

This Kentucky Medicaid Humana payment policy governs facility reimbursement when a long-acting reversible contraceptive device (IUD or implant) is inserted for a postpartum inpatient, and explains billing instructions and applicable HCPCS codes.

Policy Summary

PayerHumana

PolicyLong-Acting Reversible Contraception While Inpatient Postpartum

Policy CodePolicy CP2024002

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit UB-04 (or electronic equivalent) with TOB 11x for facility claims and follow plan requirements for medical necessity and applicable referrals/authorizations.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

separately reimbursedLARC insertion payment vs DRG

6HCPCS codes listed for device insertion

facility-onlyPolicy applies to facility services

TOB 11xType of bill required for UB-04 submission

Inpatient postpartum LARC facility reimbursement criteria

Facility reimbursement criteria for inpatient postpartum LARC insertion:

ALL of the following

ALL of the following
- Facility inpatient postpartum (LARC inserted during an inpatient postpartum stay)
ALL of the following
- Insertion is reimbursed separately from the inpatient labor and delivery DRG and paid at the fee schedule rate
ALL of the following

Policy Summary

PayerHumana

PolicyLong-Acting Reversible Contraception While Inpatient Postpartum

Policy CodePolicy CP2024002

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit UB-04 (or electronic equivalent) with TOB 11x for facility claims and follow plan requirements for medical necessity and applicable referrals/authorizations.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Claims submission and plan requirements

Documentation Required

Submit UB-04 (TOB 11x) and meet standard plan requirements

Submit facility claims on a UB-04 (or electronic equivalent) using a type of bill with TOB 11x and report the appropriate LARC HCPCS code(s). Claims remain subject to standard plan requirements including medical necessity, reasonableness and any applicable referral/authorization rules.

Use UB-04 claim form or electronic equivalent with TOB 11x for facility inpatient postpartum LARC insertion.
Report insertion with HCPCS code J7296, J7297, J7298, J7300, J7301 or J7307.
Claims are subject to medical necessity, reasonableness, and applicable referral/authorization requirements; out-of-network rules may apply for Humana Healthy Horizons in Kentucky.

Definitions and code-specific notes

LARC — definition

DefinitionLong-acting reversible contraception (LARC): birth control devices that provide long-term pregnancy prevention; includes intrauterine devices (IUDs) and implants.

TypesIncludes intrauterine devices (IUDs) and contraceptive implants.

EffectivenessMost effective form of reversible birth control with a failure rate of less than 1%.

J7296 — HCPCS code

HCPCS codeJ7296

DescriptionLevonorgestrel-releasing intrauterine contraceptive system (Kyleena), 19.5 mg.

Device typeLevonorgestrel-releasing intrauterine device (IUD).

J7297 — HCPCS code

HCPCS codeJ7297

DescriptionLevonorgestrel-releasing intrauterine contraceptive system (Liletta), 52 mg.

Device typeLevonorgestrel-releasing intrauterine device (IUD).

J7298 — HCPCS code

HCPCS codeJ7298

DescriptionLevonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg.

Device typeLevonorgestrel-releasing intrauterine device (IUD).

J7300 — HCPCS code

HCPCS codeJ7300

DescriptionIntrauterine copper contraceptive.

Device typeCopper-containing intrauterine device (IUD).

J7301 — HCPCS code

HCPCS codeJ7301

DescriptionLevonorgestrel-releasing intrauterine contraceptive system (Skyla), 13.5 mg.

Device typeLevonorgestrel-releasing intrauterine device (IUD).

J7307 — HCPCS code

HCPCS codeJ7307

DescriptionEtonogestrel (contraceptive) implant system, including implant and supplies.

Device typeSubdermal contraceptive implant system.

OpenPayer

Long-Acting Reversible Contraception While Inpatient Postpartum

Inpatient postpartum LARC facility reimbursement criteria

HCPCS codes for inpatient postpartum LARC insertion

Claims submission and plan requirements

Definitions and code-specific notes

J7296	Levonorgestrel-releasing intrauterine contraceptive system (Kyleena), 19.5 mg
J7297	Levonorgestrel-releasing intrauterine contraceptive system (Liletta), 52 mg
J7298	Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg
J7300	Intrauterine copper contraceptive
J7301	Levonorgestrel-releasing intrauterine contraceptive system (Skyla), 13.5 mg
J7307	Etonogestrel (contraceptive) implant system, including implant and supplies