Paragard Access Center®
Paragard® Billing & Reimbursement
Documenting Paragard IUS placement and subsequent care with appropriate coding is a key part of the billing process. The CPT/J-codes below may be used when filing claims. Be sure to check with your patient’s individual insurance carrier, as payers vary in their claim reporting requirements.
58300 Intrauterine contraceptive device insert
J7300 Intrauterine copper contraceptive
CPT procedure Codes do not include the cost of Paragard. Use the Healthcare Common Procedure Coding System (HCPCS)/J-Code, J7300, to report use of a unit.1
To complete the claim, you may also need to report:
Drug name: Paragard T380A (intrauterine copper contraceptive)
National Drug Code (NDC):
|Teva Women’s Health||51285-0204-01|
Route of administration: Intrauterine
How supplied: Carton of 1 sterile unit
How to Appeal an Under-Reimbursed Claim
Before beginning a formal appeal process, you should first do the following:
- Call the health plan to confirm the procedure required for the appeal, verify eligibility and reimbursement amounts
- Be prepared to provide the health plan with the claim number and all the information on the original claim that was not paid correctly
- Amounts may vary due to special contracts between an employer group and the health plan, so be prepared to provide the health plan with the employer name and/or group number
- If not satisfied after calling the health plan, you may want to file a letter of appeal with the health plan and include the original claim
How to Create an Appeal Letter for Paragard (HCPCS J7300)
Create your own letter to address the under-reimbursement or utilize the Sample Letter of Appeal for Payment HCPCS J7300.
- If using the Paragard sample letter of appeal template – please copy and paste content onto practice letterhead, fill in the blanks accordingly, and add any additional information to support your appeal
Please include the following documents with your appeal letter to assist with the health plans consideration and determination for adjusting payment:
- Original Claim
- Price Increase Letter to Healthcare Providers
- Price Increase Letter to Health Plans
- Paragard Patient Brochure
NOTE: Some health plans will require or request a copy of the invoice purchase price.
Disclaimer: The patient’s health plan should always be the first line of contact when disputing a claim. Filing an appeal for under-reimbursement may or may not result in an adjustment of payment. There are no guarantees of payment at any particular rate, and coverage and payment rates may vary depending on a number of factors (e.g., payor coverage policies, provider contracts).