CPT® codes and descriptions only are copyright 2022 American Medical Association.
9 | Family Planning Billing Guide
Definitions
This section defines terms and abbreviations, including acronyms, used in this
billing guide. Refer to chapter 182-500 WAC for a complete list of definitions for
Washington Apple Health.
340B dispensing fee – HCA’S established fee paid to a registered and Medicaid-
participating 340B drug program provider under the public health service (PHS)
act for expenses involved in acquiring, storing and dispensing prescription drugs
or drug-containing devices (see WAC 182-530-7900). A dispensing fee is not paid
for nondrug items, devices, or supplies (see WAC 182-530-7050).
Applicant – A person applying for Family Planning Only services.
Comprehensive preventive family planning visit – A comprehensive,
preventive, contraceptive visit that includes evaluation and management of an
individual, such as: age-appropriate history, examination, counseling/anticipatory
guidance, risk factor reduction interventions, and laboratory and diagnostic
procedures that are covered under the client’s respective HCA program.
Contraception – Prevention of pregnancy using contraceptive methods.
Contraceptive – Food and Drug Administration (FDA)-approved prescription and
nonprescription methods, including devices, drugs, products, methods, or
surgical interventions used to prevent pregnancy, as described in WAC 182-530-
2000.
Family planning clinic – A clinic that is designated by HCA to provide family
planning services to eligible people as described in this guide. Other types of
providers may offer family planning services within their scope of practice.
Family Planning Only program - The program that covers family planning only
services for eligible clients for 12 months from the date HCA determines
eligibility.
Family Planning Only – Pregnancy Related program – The program that
covers family planning only services for eligible clients for 10 months following
the 60-day post pregnancy period.
Family planning services – Medically safe and effective medical care,
educational services, and contraceptives that enable individuals to plan and space
the number of children they have and avoid unintended pregnancies.
Informed consent – When an individual consents to a procedure after the
provider who obtained a properly completed consent form has done all of the
following:
• Disclosed and discussed the client’s diagnosis
• Offered the client an opportunity to ask questions about the procedure and
request information in writing
• Given the client a copy of the consent form
• Communicated effectively using any language interpretation or special
communication device necessary per 42 CFR 441.257
• Given the client oral information about all the following: