Attention Section 30, Family Planning Service Providers: Medicare Benchmark Adjustments for January 1, 2023

Mar 27, 2023

Effective January 1, 2023, the Department updated reimbursement rates for certain Medicare covered codes and services for section 30, Family Planning services. These updated rates reflect 72.4% of the 2023 Medicare rates, and are listed on the provider fee schedule as “base rates.” The fee schedule also shows new add-on payment amounts and resulting total rates for certain services for eligible providers only. See the e-message from earlier today for details about the add-on payments.

The Department will reprocess claims that providers submitted at or above the updated base rates from January 1, 2023, through March 15, 2023.   

Note that these rate updates only apply to certain services benchmarked to Medicare under Section 30. When a Section of Policy cross-references rates in a separate Section of Policy, the reimbursement provisions in the cross-referenced section of policy dictate the reimbursement amount. 

Please contact your Provider Relations Specialist for questions.