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CPT Codes and ICD-10 Diagnosis Codes
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CPT Code Description of Covered Codes
Evaluation and Management 99384FP 99385FP Family planning new visit 99386FP 99394FP 99395FP^ Family planning established visit 99396FP 99401FP HIV counseling (pre-test) 15 min 99402FP HIV counseling (post-test) 30 min 99403FP Family planning counseling visit 99211FP Family planning supply visit 99202 Extended family planning services-new patient (treatment of STI) 99211 Extended family planning services-established patient (treatment of STI) Medication/Device J1050 Injection medroxyprogesterone acetate (Depo-Provera) J7300 Intrauterine copper device (Paraguard) J7301 Levonorgestrel-releasing intrauterine contraceptive system (Skyla), 13.5 mg J7297 Levonorgestrel-releasing intrauterine contraceptive system (Liletta), 52 mg J7298 Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg J7307 Etonogestrel implant system, including implant and supplies (Nexplanon) J7296 Levonorgestrel-releasing intrauterine contraceptive (Kylenna), 19.5 mg Anesthesia, Surgical and Radiology 00840 Anesthesia for Intraperitoneal procedures in lower abdomen including laparoscopy 00851 Anesthesia for tubal ligation/transection 11976 Removal of implantable contraceptive capsules 11981 Insertion, non-biodegradable drug delivery implant 11982 Removal, non-biodegradable drug delivery implant 11983 Removal with reinsertion, non-biodegradable drug delivery implant 57170 Diaphragm or cervical cap fitting with instructions 57410 Pelvic examination under anesthesia 57452 Colposcopy of the cervix 57454 Colposcopy with biopsy(s) of the cervix and endocervical curettage 57460 Colposcopy with loop electrode biopsy(s) 58300 Insertion of intrauterine device 58301 Removal of intrauterine device
58340 Catheterization and introduction of saline or contrast material for saline infusion forhysterosalpingography
58600 Ligation or transection of fallopian tube(s) 58615 Occlusion of fallopian tube(s) by device (e.g. band, clip, Falope ring) 58670 Surgical laparoscopy, with fulguration of oviducts (with or without transection)
58671 Surgical laparoscopy, with occlusion of oviducts by device (e.g. band, clip, or Falope ring) 74740 Radiological supervision and interpretation x-ray of uterine tubes and ovaries 76856 Ultrasound of pelvis, non-obstetric (to check placement of intrauterine devices)
CPT Codes and ICD-10 Diagnosis Codes
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76882 Ultrasound of extremity, limited, anatomic specific (to check for implantable contraceptive device) Laboratory 81000 Urinalysis, non-automated, with microscopy 81001 Automated, with microscopy 81002 Non-automated, without microscopy 81003 Automated, without microscopy 81005 Urinalysis; qualitative or semi-qualitative 81007 Urinalysis; bacteriuria screen, by kit 81015 Urinalysis; bacteriuria screen, microscopic only 81025 Urine pregnancy test, by visual color comparison 82947 Glucose; quantitative, blood 84702 Gonadotropin, chorionic (hCG); quantitative 84703 Gonadotropin, chorionic (hCG); qualitative 85007 Blood count; manual differential WBC count 85014 Hematocrit 85018 Hemoglobin 86255 Fluorescent antibody; screen, each antibody (HIV & herpes) 86382 Neutralization test, viral 86403 Rubella screen (IgG) 86580 Tuberculosis, intradermal 86592 Syphilis test; qualitative (e.g., VDRL, RPR, ART) 86593 Syphilis test; quantitative 86689 HTLV or HIV antibody, confirmatory test (western blot) 86694 Herpes simplex, non-specific type test 86695 Herpes simplex, type I 86696 Herpes simplex, type 2 86701 Antibody; HIV- 86702 Antibody; HIV- 86703 Antibody; HIV-1 and HIV-2, single assay 86706 Hepatitis B surface antibody (HBsAb) 86707 Hepatitis Be antibody (HBeAb) 86762 Rubella titer 86780 Treponema pallidum 86803 Hepatitis C antibody 87070 Culture, bacterial, definitive; any other source (GC) 87075 Culture, bacterial, any source; anaerobic (isolation) 87081 Culture, bacterial, screening only (GC)
87086 Culture, bacterial, urine; quantitative, colony count
87088 Culture, bacterial, urine; quantitative colony count, with isolation and presumptiveidentification of each isolate
87110 Culture, chlamydia 87164 Dark field examination, any source, includes specimen collection
87205 Smear, primary source, with interpretation; Gram or Giemsa stain for bacteria, fungi,or cell types; (gonorrhea)
87206 Smear, primary source, with interpretation; (chlamydia)
CPT Codes and ICD-10 Diagnosis Codes
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88155 Cytopathology, slides, cervical or vaginal, with definitive hormonal evaluation
88164
Cytopathology, slides, cervical or vaginal, (Bethesda System); with manual screening under physician supervision
88165
Cytopathology. slides, cervical or vaginal (Bethesda System);with manual screen & re- screen under physician supervision
88166 Cytopathology, slides, cervical or vaginal (Bethesda System), manual screen & computer-assisted re-screen under physician supervision
88167 Cytopathology, slides, cervical or vaginal, (Bethesda System), using cell selection andreview under physician supervision
Cytopathology, cervical or vaginal, (any reporting system), collected in preservative fluid, automated thin layer preparation, screen by automated system, under physician supervision
88175 With screen by automated system and manual rescreening or review, under physician supervision 88302 Level II surgical pathology, gross and microscopic (sterilization)
88305 Level IV surgical pathology, gross and microscopic (colposcopy)
ICD-10 Code Description of Covered Diagnosis Codes
A51 Early syphilis (Select appropriate diagnosis code) A51.0 โ A51. A53.
A60 Anogenital herpesviral(herpes simplex) infections (Select appropriate diagnosis code) A60.0 - A60.
A54 Gonococcal infection (Select appropriate diagnosis code) A54.0 โ 54. A54.24 โ A54. A54.5 โ A54. A54.
A55 Chlamydial Infections (Select appropriate diagnosis code) A56.0 โ A56. A74.89-A74.
A57 Chancroid A58 Granuloma Inguinale A59 Trichomoniasis (Select appropriate diagnosis code) A59.0 โ A59.
A60 Anogenital herpesviral Infections (Select appropriate diagnosis code) A60. A60.03โA60.
CPT Codes and ICD-10 Diagnosis Codes
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A
Other predominantly sexually transmitted diseases, not elsewhere classified (Select appropriate diagnosis code) A63.0 - A
B37 Candidiasis (Select appropriate diagnosis code) B37.3-B37. B07.8-B07.9 Other viral warts
N34.1 Nonspecific urethritis
N86 Erosion and ectropion of cervix uteri N87.0 - N87.9 Cervical dysplasia
N87.1 Moderate cervical dysplasia N87.9 Dysplasia of cervix uteri, unspecified (Select appropriate diagnosis code)
N88 Other noninflammatory disorders of cervix uteri (Select appropriate diagnosis code) N88.0 - N88.
R87.
Abnormal cytological findings in specimens from female genital organs (Select appropriate diagnosis code) R87.610 - R87.
Z01.41 Encounter for gynecological examination (Select appropriate diagnosis code) Z01.411 - Z01.
Z11.5 Encounter for screening for other viral diseases (Select appropriate diagnosis code) Z11.51-Z11.
Z30 Encounter for contraceptive management (Select appropriate diagnosis code) Z30.0 - Z30.
Z30.2 Encounter for sterilization
Z32.0 Encounter for pregnancy test (Select appropriate diagnosis code) Z32.00- Z32.
