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New Jersey

Payer Coverage Reimbursement Other

1199 Health and Human Services Employees Union

Mifeprex is covered to the same extent as surgical abortion.

Providers should submit claims for Mifeprex using code W0486. Providers should use regular E&M codes for office visits. Office visits and related services should be billed separately.

Both OB/GYNs and family practitioners will be reimbursed. If a family practice physician is providing Mifeprex, but is not the primary care provider for the patient, a referral is not needed if the family practice physician is a member of the PPO.

21st Century Health & Benefits

Mifeprex is covered to the same extent as surgical abortions.

Office visits are reimbursed using regular E&M codes. Providers should use S0190 for Mifeprex and S0191 for misoprostol.

Ob/gyns and family practitioners are covered. No referrals for FPs are needed.

Aetna US Healthcare

Mifeprex is covered to the same extent as surgical abortions.

Reimbursement for a patient's non-primary care physician uses E/M codes for office visits; the drug is reimbursed using code J3490 and is paid based on the physician's invoice cost. If the patient's primary care physician is providing Mifeprex and s/he is capitated, the office visits are under the capitation. The drug cost is reimbursed separately based on the invoice cost.

OB/GYNS will not need a referral to provide Mifeprex to their patients. If an internist or family practice physician is providing Mifeprex but s/he is not the primary care provider for the patient, a referral will be needed.

AmeriHealth

Mifeprex is covered to the same extent as surgical abortion.

Associated office visits and supplies are covered as a bundled rate with code S0199. Providers should submit claims for Mifeprex using code S0190 and for misoprostol using S0191. Mifeprex will be reimbursed at the AWP minus 10%.

Family practitioners and ob/gyns are covered. A referral is needed is a patient obtains Mifeprex from a family practitioner who is not her PCP.

CIGNA

Mifeprex is covered to the same extent as surgical abortion.

Mifeprex should be submitted using S0190 and misoprostol using S0191. Regular E&M codes should be used for office visits.

Family practitioners are covered. A referral is needed if a patient obtains Mifeprex from a family practitioner who is not her PCP.

Great-West/One Health Plan

Mifeprex is covered to the same extent as surgical abortions.

Office visits are reimbursed using regular E&M codes. Providers should use S0190 for Mifeprex and S0191 for misoprostol.

Family practitioners are covered. A referral is needed if the family practitioner is not the patient’s primary care physician.

Healthnet

Mifeprex is covered to the same extent as surgical abortion.

Providers should submit claims for Mifeprex using code J8499. The claim form must include the name of the drug, the NDC number, and the dosage. Providers should use regular E&M codes for office visits.

Healthnet will reimburse family practitioners. Under the Passport plan, if a family practitioner is providing Mifeprex, but is not the primary care provider for the patient, a referral (either prescription or telephone) will be needed. Under the Charter plan, no such referral is needed.

Horizon Blue Cross and Blue Shield of New Jersey

Mifeprex is covered to the same extent as surgical abortion.

Office visits should be billed using normal E&M codes and will be paid at regular office visit rates. Providers should submit claims for Mifeprex using code S0190 and for misoprostol using S0191. All other services (i.e., ultrasounds) can be submitted separately and will be paid according to the normal fee-for-service rates.

Oxford

Mifeprex is covered to the same extent as surgical abortions.

Mifeprex is covered using code S0199 for the procedure, S0190 for Mifeprex and S0191 for Misoprostol. Primary care physicians, including family practitioners, can bill for the service. The mifeprex claim should include the NDC# 64875-001-03. Office visits, ultrasound, and other ancillary services are billed separately and are reimbursed based on the regular fee schedule.

United HealthCare

Mifeprex is covered to the same extent as surgical abortion.

Office visits should be billed using normal E&M codes and will be paid at regular office visit rates. Providers should submit claims for Mifeprex using code J8499. All other services (i.e., ultrasounds) can be submitted separately and will be paid according to the normal fee-for-service rates.

State Medicaid Information

Department of Human Services of New Jersey
Quakerbridge Plaza, Building 7
P.O. Box 712
Trenton, NJ 08625-0712
Local: 1-609-588-2600
Toll free: In-State Calls Only 1-800-356-1561
Spanish: 1-800-356-1561
www.state.nj.us/humanservices/dmahs

IMPORTANT SAFETY INFORMATION

Although cramping and bleeding are an expected part of ending a pregnancy, rarely, serious and potentially life-threatening bleeding, infections, or other problems can occur following a miscarriage, surgical abortion, medical abortion, or childbirth. Prompt medical attention is needed in these circumstances. Serious infection has resulted in death in a very small number of cases; in most of these cases misoprostol was used in the vagina. There is no information that use of Mifeprex and misoprostol caused these deaths. If you have any questions, concerns, or problems, or if you are worried about any side effects or symptoms, you should contact your provider.

Be sure to contact your provider promptly if you have any of the following:

Heavy Bleeding. Contact your provider right away if you bleed enough to soak through two thick full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding. In about 1 out of 100 women, bleeding can be so heavy that it requires a surgical procedure (surgical abortion/D&C) to stop it.

Abdominal Pain or “Feeling Sick”. If you have abdominal pain or discomfort, or you are “feeling sick”, including weakness, nausea, vomiting, or diarrhea, with or without fever, more than 24 hours after taking misoprostol, you should contact your provider without delay. These symptoms may be a sign of a serious infection or another problem (including an ectopic pregnancy, a pregnancy outside the womb).

Fever. In the days after treatment, if you have a fever of 100.4°F or higher that lasts for more than 4 hours, you should contact your provider right away. Fever may be a symptom of a serious infection or another problem (including an ectopic pregnancy).

Take your MEDICATION GUIDE with you. When you visit an emergency room or a provider who did not give you your Mifeprex, you should give them your MEDICATION GUIDE so that they understand that you are having a medical abortion with Mifeprex.

Mifeprex* is a registered trademark
of Danco Laboratories, LLC
1-877-4 Early Option
1-877-432-7596
info@earlyoptionpill.com
FDA approved since 2000.
A safe and effective non-surgical option for ending early pregnancy.