5101:3-21-01 Medicaid covered reproductive health services: preconception care services.

(A) "Preconception care" means medicaid-covered preventive medicine services provided prior to a pregnancy for the purpose of achieving optimal outcome of future pregnancies.

(B) Medicaid covered preconception care services may include, but are not limited to:

(1) Laboratory tests and procedures including but not limited to:

(a) Screening, diagnostic, and counseling services for detection of genetic anomalies and/or hereditary metabolic disorders, including but not limited to:

(i) Chromosomal anomalies (in non-pregnant patients) that have neonatal implications;

(ii) Sickle cell and other abnormal hemoglobin syndromes;

(iii) Metabolic disorders such as phenylketonuria (PKU), galactosemia, or homocystinuria; and

(iv) Cystic fibrosis (carrier status);

(b) Screening for, diagnosis of, and treatment of sexually transmitted diseases and infections;

(2) Individual preventive medicine counseling and or risk factor reduction(s) (health education), in accordance with appendix DD to rule 5101:3-1-60 of the Administrative Code.

(C) For reimbursement of preconception care services medicaid providers must use:

(1) Valid medicaid-covered CPT and/or HCPCS procedure codes as defined in paragraph (D) of rule 5101:3-1-19.3 of the Administrative Code; and

(2) Appropriate "International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)" diagnosis codes V 26.31 through V 26.4, V 26.8, and/or V 26.9 to indicate an encounter for preconception care.

Effective: 07/01/2009
R.C. 119.032 review dates: 07/01/2014
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01, 5111.02, 5111.021