Author Topic: Billing IUD's for OB/GYN  (Read 8396 times)


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Billing IUD's for OB/GYN
« on: May 02, 2011, 11:02:22 AM »
Wondering if anyone can help with this;

We are located in the Atlanta area and my doctors do IUD's as well as insertion of implatable contraceptive capsules.

I am finding that compared to what the doctors are paying for the drugs and what the insurances allowables are, we are barely making money on these, and at times even losing money.

I know that other doctors must be making money on the IUD's or they wouldn't be doing them.

Below are;  1) the codes with description, 2) the cost of the drugs to our practice and,
 3) the billing/coding combinations we are using to bill out services.

11975 - Insertion, implantable contraceptive capsules    
11981 - Insertion, non-biodegradable drug delivery implant         
11983 - Removal with reinsertion, non-biodegradable drug delivery implant   
58300 - Insertion of IUD   
J7300 - Paragard IUD   
J7302 - Mirena IUD   J
7306 - Levonorgestrel   
J7307 - Implanon   
J1055/J1051 - Depo-provera                        
Cost to practice                     
J7300 - $625.00                     
J7302 - $701.00                     
J7307 - $625.00                     
J1051/J1055 - $23.35                        
Billing Combinations                     

Any advice?


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Re: Billing IUD's for OB/GYN
« Reply #1 on: May 05, 2011, 08:34:41 PM »
Do you know the approximate allowed amount the insurances pay on the codes J7300 and 58300?

I've billed for an OB/GYN here in Texas and our approximates for J7300 were around $415.00 but the practice's amt was around $500.00. For 58300 about $72.00 and practice price around $250.00.

It must vary between states and of course, insurances. That was from MCD.

I billed the

J7300      V25.09
58300      V25.09       

no modifier and was always paid.   


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Re: Billing IUD's for OB/GYN
« Reply #2 on: May 06, 2011, 06:45:31 AM »
Insurances vary.  I would recommend looking at Medicare fee schedule to get a general idea of what is allowed.  Many insurance carriers base their RNC on some formula containing the Medicare allowed amount.
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Re: Billing IUD's for OB/GYN
« Reply #3 on: May 06, 2011, 05:44:18 PM »
We bill for a midwifery practice in NM who also do a lot of IUD inserts and family planning.  They also are just barely making ends meet on the IUDs, so after we verified the insurance companies were paying the contracted amount, they went to their reps and are renegotiating their contract.

Some plans allow "free" or reduced-rate IUDs from a specific pharmacy, other plans require the patient to obtain the device before insert. All of this is found out during the verification of benefits.

They also see the patient for an office visit before the insert, which helps with reimbursement rates.
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC


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Re: Billing IUD's for OB/GYN
« Reply #4 on: August 03, 2011, 10:56:19 AM »
I work for an OB/GYN in Alabama.  Medicaid pays us $702 for the IUD which is exactly our cost and $97 for insertion. If we order several IUD's at one time the cost per IUD is less so we make a little more money on the IUD.