Choose Another State
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.
Blue Cross and Blue Shield of Vermont Mifeprex is covered to the same extent as surgical abortions. Reimbursement for the office visits uses E/M codes. The drugs are reimbursed using either J3490 or J8499. All other services are reimbursed separately, if medically necessary

Vermont State Medicaid Information

<p class="p1"><span class="s1">Agency of Human Services of Vermont<br /> 103 South Main Street<br /> Waterbury, VT 05676-1201<br /> Local: 1-802-879-5900<br /> Toll free: In-State Calls Only 1-800-250-8427<br /> TTY: 1-802-241-1282<br /> <a href="http://ovha.vermont.gov/"><span class="s2">www.ovha.state.vt.us</span></a></span></p>