Minnesota Family Planning Program (MFPP) Procedure Codes
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1 Revised: Minnesota Family Planning Program (MFPP) Procedure Codes Anesth, surg low abdmn Anesth, tubal lig/transect Anesth, genitalia surgery Anesth, vasectomy Anesth, vaginal endoscopy Anesth, uterine endoscopy Removal of contracep cap Insert drug implant device Remove drug implant device Diag laparo separate proc Laparoscopy, biopsy Lap proc, abdm/per/omentum Cystoscopy & duct catheter Biopsy of testis, needle Biopsy of testis, incis Exploration of epididymis Excision epididymis lesion Fuse sperm ducts, unilateral Fuse sperm ducts, bilateral Vas cannul w/wo incis Vas, uni/bilat postop semen exam Prep for sperm duct x-ray Repair sperm duct Ligation sperm duct Excis sperm cord lesion Revise sperm cord veins Revise sperm cord veins abd Excis hernia & sperm veins Vesiculotomy Vesiculotomy; complicated Excis Mullerian duct cyst Electroejaculation Vag irrigate/med app tx Insert pessary sup device Fit diaphragm/cap Pelvic exam under anesth Endocervical curettage Revision of cervix
2 57720 plastic repair cervix Dilation of cervical canal Biopsy uterus lining Dilation & curettage Myomectomy abd approach Myomectomy vag approach Insertion IUD Remove IUD Inject for ut/tube x-ray Reopen fallopian tube Chromotubation oviduct Uterine suspension Hyseroplasty, (Strassman) Hysteroscopy, diagnostic Hysteroscopy, biopsy Hysteroscopy, lysis Hysteroscopy resect septum Hysteroscopy remove myoma Hysteroscopy bi tube cannul Ligate/transect tubal, ab/vag Lig/tran tubal uni/bi postpart same stay Ligation oviduct(s) Fal tube occlusion w device Laparoscopy lysis Lap w fulg ovid w/wo transect Lap w occlus ovid by device Laparoscopy fimbrioplasty Laparoscopy salpingostomy Salpingectomy Lysis of adhesions Revise ovarian tube(s) Fimbrioplasty Salpingostomy Transposition, ovary(s) Biopsy of ovary Wedge resec/bisect ovary uni/bi Rad exam, abd 1 anteropost Hysterosalpingography X-ray fallopian tube Echography pelvic complete
3 76857 Echography pelvic Echography scrotum Ultrasound transrectal Echo guide ova aspiration DXA axial DXA appendicular Lipid panel Hepatic function panel Urinalysis with microscopy Urinalysis auto w/scope Urinalysis nonauto no scope Urinalysis auto w/o scope Urinalysis Single Compon Urinalysis qual/semiquan Urine volume measurement Urinalysis for bacteriuria Urinalysis Con & Dilu Test Urinalysis H2ODep Test Urine H2O Dp Tst w Vso Rsp microscopic urine exam Urine Pregnancy Test Test feces for blood Assay serum cholesterol Estradiol Folic acid; serum Assay quantitative glucose Glucose tolerance test GTT Gn pituitary FSH bioassay Gonadotropin FSH Gonadotropin LH Hemoglobin assay ph body fluid assay Prolactin TSH hcg quantitative hcg qualitative Ovulation tests Bleeding time Automated diff wbc count Differential WBC count
4 85008 Nondifferential WBC count Spun microhematocrit Hematocrit Hemoglobin Auto hemogram diff WBC Auto CBC Manual cell count each Automated count platelet Prothrombin time Sedimentation rate non-auto Rbc sed rate, auto PTT Blood serology qualitative Blood serology quantitative Antibody; Chlamydia Antibody; Chlamydia, IgM Antibody; HTLV-I Antibody; HTLV-II HTLV/HIV confirm test Herpes simplex type Herpes simplex type HIV HIV HIV-1/HIV-2 single assay Hep B surface ab test Treponema pallidum, confirm Hep C antibody Bac cult not urine,bld/stool Culture bacteria specimen Culture bacteria screen Urine cult quan count Bac cult w isol &ID isolates Mycoplasma cult Culture chlamydia culture typing fluorescent Antibiotic sensitivity Antibiotic sensitivity Smear stain & interpret Smear stain & interpret Smear stain & interpret
5 87210 Smear stain & interpret Virus inoculate for test Virus inoculate shell vial Genet virus isolate, hsv Chylmd trach ag, dfa Herpes simplex 2, ag, if Herpes simplex ag, dfa Influenza b, ag, if Chylmd trach ag, eia Hep b surface ag, eia Infect antigen detect Infect antigen det HIV Hiv-2 ag, eia Ag detect nos, eia, mult Chylmd trach dna dir probe Chylmd trach dna amp probe Chylmd trach, dna, quant Hsv, dna, dir probe Hsv, dna, quant Hhv-6, dna, dir probe Hhv-6, dna, amp probe Hhv-6, dna, quant Hiv-1, dna, dir probe Hiv-1, dna, amp probe Hiv-1, dna, quant Hiv-2, dna, dir probe Hiv-2, dna, amp probe Hiv-2, dna, quant N.gonorrhoeae dna dir prob N.gonorrhoeae dna amp prob N.gonorrhoeae dna quant Hpv, dna, dir probe Hpv, dna, amp probe Hpv, dna, quant Detect agnt nos dna dir Detect agnt nos dna amp Detect agnt nos dna quant Detect agnt mult dna direc Chylmd trach assay w/optic Cytpath crv/vag interp
6 88142 Cytpath crv/vag t/layer Cytpath c/vag t/layer redo Cytpth c/vag t/layer auto Cytpth c/vag t/layer selct Cytpath c/vag automated Cytpath c/vag auto rescrn Cytopath, pap smear Cytopath interpret Cytopath cerv/vag auto Cytpath c/vag redo Cytpath c/vag select Cytopath pap smear TBS smear Bethesda System TBS smear Bethesda System Cytopath cerv/vag tbs auto Cytopathology Cytopathology Extensive cytopathology Cytpath tbs c/vag manual Cytpath tbs c/vag redo Cytpth tbs c/vag auto redo Cytpath tbs c/vag select Cytopath c/v auto in fluid Cytpth c/v auto fluid redo Level 1 surg path gross only Lev 2 surg path gross & micro appendix incidental fall tube sterilization Semen analy; include Huhner test Semen analysis Vascular study Dup scn flw art in&ven out Ther/proph/diag inj, sc/im Grp health ed Office/outpt visit new pt Office/outpt visit new pt Office/outpt visit new pt Office/outpt visit new pt Office/outpt visit new pt Office/outpt visit new pt Office/outpt visit est pt Office/outpt visit est pt
7 99214 Office/outpt visit est pt Office/outpt visit est pt Office consultation Office consultation Office consultation Office consultation Office consultation Prevent visit new Prevent visit new Prevent visit new Prevent visit est Prevent visit est Prevent visit est Prev counsel indv 15 min Prev counsel indv 30 min Prev counsel indv 45 min Prev counsel indv 60 min Prev counsel grp 30 min Prev counsel grp 60 min A4261 Cerv cap contracep A4266 Diaphragm A4267 Male condom A4268 Female condom A4269 Spermicide G0027 Semen analysis pres/mot H1010 Nonmed fam plan ed J1050 Medroxyprogesterone acetate 1mg inject J7300 copper IUD *J7302 Levonorgestrel IUD system *J7303 Contracept vaginal ring *J7304 Contracept patch *J7306 Levonorgestrel imp system J7307 Etonogestrel impl system Q0090 Levonorgestrel IUD system (13.5mg) Q0091 Pap smear *S4989 Contracept IUD *S4993 Contracept BC pills T1013 Oral language interp *Indicates the HCPCS code requires an NDC dispensing unit and the quantity when billing MHCP.
8 Secondary MFPP Procedure Codes Code/Range Description J0561 Inj penicillin G benz to 2.4 mil units *J0696 Inj ceftriaxone sodium *J8499** Prescription drug, oral, NOS Use to report CDC recommended drugs for treatment of STIs when dispensed in the office, for example Amoxicillin, Cefixime, Ciprofloxacin, Clindamycin, Clotrimazole, Doxycycline, Fluconazole, Metronidazole, Nitrofurantoin, Ofloxacin, Sulfa-methoxazole/Trimethoprim, Terconazole. List the drug, dosage and number of tablets dispensed in the comments section of the services tab for that individual service line in MN ITS *Q0144 Azithromycin, oral capsule Incis & drain abscess Incis & drain hematoma Wart destruction Destroy penis lesions, chem Destroy penis lesions, cryo Destroy vulva lesions Destroy vaginal lesions Colposcopy cervix incl up/adj vagina Colposcopy, w bio cervix Colposcopy, w loop biop cervix conization Cautery of cervix; Level IV - Surg path, gross and micro Level V - Surg path, gross and micro *Indicates the HCPCS code requires an NDC when billing MHCP. Refer to NDC Reporting Clarification for additional information. **In addition to the NDC, J8499 continues to require the drug, dosage and number of tablets dispensed in the comments.
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