Do you see Medicaid patients for contraception? Consider contacting the state HHSC!

Upcoming change to policy: If a provider bills for J7307 (Nexplanon) to Medicaid at the proposed rate, it will be below the price in which a private provider is spending. However, HHSC is proposing to amend the fee schedule to other LARC codes if they hear from us by Friday February 14th!

Primary Points:

Proposed Adjustments to Fees, Rates, or Charges for Medicaid Biennial Calendar Fee Review of Long-Acting Reversible Contraceptives (LARCs).

From HHSC: 04-01-2025-biennial-cal-fee-review-larcs.pdf

(0%) change in payment for J7307. If a provider bills for J7307 at the proposed rate, it will be below the price in which a private provider is spending. However, HHSC is proposing to amend the fee schedule to other LARC codes. 

What can you do?

Please consider supporting increased reimbursement rates for J7307 so that:

• Health care practitioners can offer the full range of LARCs to Medicaid patients seeking reproductive health services without reimbursement barriers and disparities.
• Medicaid patients have equal access to the LARC that best meets their needs and that they request, not just the one their health care provider can afford to offer based on Medicaid reimbursement.
• Medicaid patients have a choice of the only non-uterine LARC when an IUD is not clinically appropriate for them.

WRITTEN COMMENTS

Written comments regarding the proposed payment rate adjustments will be accepted in lieu of, or in addition to, oral testimony until 5 p.m. the day of the hearing (Feb. 14th). Written comments may be sent by:

• E-mail to PFDAcuteCare@hhs.texas.gov
• Fax to Provider Finance Department at (512) 730-7475
• U.S. mail to the Texas Health and Human Services Commission, Attention: Provider Finance Department, Mail Code H-400, P.O. Box 149030, Austin, Texas 78714-9030
• In addition, written comments will be accepted by overnight mail or hand delivery to Texas Health and Human Services Commission, Attention: Provider Finance Department, Mail Code H[1]400, North Austin Complex, 4601 W Guadalupe St, Austin, Texas