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Payer Coverage Reimbursement Other
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.
Alabama Medicaid Mifeprex is covered to the same extent as surgical abortions (only in the case of rape or a life-threatening illness due to the pregnancy). Providers should use S0190 for Mifeprex and S0191 for misoprostol. Providers should use S0190 for Mifeprex and S0191 for misoprostol.
Cigna Mifeprex is covered to the same extent as surgical abortion. Mifeprex is covered to the same extent as surgical abortion. Family practitioners are covered. A referral is needed if a patient obtains Mifeprex from a family practitioner who is not her PCP.