Contraceptive management refers to the use of reversible methods of contraception such as contraceptive devices, implants, medications, injections, and related services (e.g., insertion/removal of an implant or IUD) for the prevention of pregnancy. Sterilization and abortion procedures are not considered to be contraceptive management services.
Coverage is subject to the specific terms of the member's benefit plan.
Federal Employee Program members (FEP) should check with their Retail Pharmacy Program to determine if prior approval is required by calling the Retail Pharmacy Program at 1-800-624-5060 (TTY: 1-800-624-5077). FEP members can also obtain the list through the www.fepblue.org website.
When contraceptive management services are provided solely for contraceptive purposes, eligibility is determined according to specific individual or group customer benefits.
There are some instances where a contraceptive device, implant, medication or injection may be used to treat a medical condition, (e.g., Depo-Provera for treatment of endometriosis, or an IUD for treatment of menorrhagia). When provided for treatment of medical conditions, and not solely for contraceptive purposes, contraceptive devices, implants, medications, injections and related services are covered in accordance with the member's contractual benefits.
When a benefit, coverage for contraceptive devices, implants, medications, injections, and related services for non-contraceptive uses (i.e., medical uses) will be limited to those medical conditions listed in the "Diagnosis Codes" section.
When contraceptive devices, implants, medications, injections and related services are provided for medical conditions other than those listed in the "Diagnosis Codes" section of this policy, it is considered as a non-covered service.