Family Planning Services

Family planning services include medically necessary services and supplies described in section 1905(a)(4)(C) of the Act related to the following:

FDA-approved methods of contraception

Sexually transmitted infection (STI)/sexually transmitted disease (STD) testing,

Pap smears and pelvic exams.

The laboratory tests done during an initial family planning visit for contraception include a Pap smear, screening tests for STIs/STDs, blood count, and a pregnancy test.

Additional screening tests may be performed depending on the method of contraception desired and the protocol established by the clinic, program, or provider. Additional laboratory tests may be needed to address a family planning problem or need during an inter-periodic family planning visit for contraception

Drugs, supplies, or devices related to women’s health services described above

Contraceptive management, patient education, and counseling.

Family planning-related services and supplies are defined as those services provided as part of, or as follow-up to, a family planning visit. Such services are provided because a “family planning-related” problem was identified and/or diagnosed during a routine or periodic family planning visit. The following are examples of the family-planning-related services:

Colposcopy (and procedures are done with/during a colposcopy) or repeat Pap smear performed as a follow-up to an abnormal Pap smear which is done as part of a routine/periodic family planning visit.

Drugs for the treatment of STIs, except for HIV/AIDS and hepatitis, follow-up visit/encounter for the treatment/drugs, and subsequent follow-up visits to rescreen for STIs based on the Centers for Disease Control and Prevention (CDC) guidelines may be covered.

Drugs for vaginal infections/disorders, other lower genital tract and genital skin infections/disorders, and urinary tract infections, where these conditions are identified/diagnosed during a routine/periodic family planning visit. A follow-up visit/encounter for the treatment/ drugs may be covered.

Other medical diagnoses, treatment, and preventive services that are routinely provided pursuant to family planning services in a family planning setting.

Treatment of major complications arising from a family planning procedure such as:

Treatment of a perforated uterus due to an intrauterine device insertion

Treatment of severe menstrual bleeding caused by a Depo-Provera injection requiring dilation and curettage

or Treatment of surgical or anesthesia-related complications during a sterilization procedure.