QUEST Integration – Abortion

Original Effective Date:

08/01/2004

Current Effective Date:

01/01/2015

Claim charges for intentional termination of pregnancy (ITOP) and services related to ITOP for QUEST Integration members must be submitted to Medicaid’s Fiscal Agent, Conduent, for payment consideration.

Services Payable by Medicaid Fiscal Agent

In addition to the surgical procedure, all services related to the ITOP procedure, including facility charges and professional services must be billed directly to Conduent at the following address:

Hawaii Medicaid Fiscal Agent

P.O. Box 1220

Honolulu,  HI 96807-1220

For Drug claims, such as Rh immunoglobulins given on the day of the ITOP to prevent sensitization of Rh-negative women, must be billed directly to Conduent at the following address:

Hawaii Medicaid Fiscal Agent

Attn: ITOP PBM Claims

P.O. Box 1480

Honolulu, HI  96806-1480

Any transportation, meals and lodging related to the ITOP for women on Neighbor Islands who need surgical ITOPs done on another island will be coordinated by the Med-QUEST Division’s Clinical Standards Office (MQD/CSO). Providers will have to complete the DHS Form 208 (Prior Authorization Request for Air Transportation, Lodging, Meals, and Ground Transportation form) and mail or fax to:

Attn: CSO – 208 Processing

P.O. Box 700190

Kapolei, HI  96709-0190

Fax: 808-692-8131

Inpatient hospital and outpatient emergency room services for the treatment of ITOP complications that occur during the procedure’s follow-up period are to be billed to Conduent. Treatment of complications after the follow-up period may be billed to HMSA QUEST Integration. See below for additional information.

Services Payable by HMSA’s QUEST Integration Plan

HMSA’s QUEST Integration plan will continue to cover medically necessary services rendered prior to a member’s decision to terminate a pregnancy. Services may include but are not limited to pregnancy testing, amniocentesis, ultrasound studies, alfa-fetoprotein, and chromosome analysis.

Other services not directly related to the ITOP should be submitted to HMSA QUEST Integration, such as contraceptive methods (ie. birth control pills, implants, injections, intrauterine devices.)

Treatment of ITOP complications after the surgical procedure follow-up period (10 or 90 days) are covered by HMSA-QUEST Integration. However, to prevent denials, the primary diagnosis must be for the complication requiring the follow-up services and not in the ITOP code range noted below. Claims coded with ITOP diagnosis codes will be denied.

ITOP Coding Guidelines

ITOP claims must be submitted with a primary/principal ICD-10 diagnosis code listed below:

Revision History