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Paragard Access Center®

Paragard Billing & Reimbursement

Billing Code

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.

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CPT Code1
58300 Intrauterine contraceptive device insert
J-Code1
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

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To complete the claim, you may also need to report:

Drug name: Paragard T380A (intrauterine copper contraceptive)
Quantity: 1
National Drug Code (NDC):

PRODUCT DESCRIPTION NDC
Paragard | Single-Hand Inserter 59365-5129-1 (10-digit)
Paragard | Single-Hand Inserter 59365-5129-01 (11-digit)
Paragard 59365-5128-1 (10-digit)
Paragard 59365-5128-01 (11-digit)

Route of administration: Intrauterine
How supplied: Carton of 1 sterile unit

Download the Reimbursement Guide

Reimbursement Appeals

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:

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).

INDICATIONS AND USAGE

Paragard is a copper-containing intrauterine system (IUS) indicated for prevention of pregnancy in females of reproductive potential for up to 10 years.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

  • The use of Paragard is contraindicated when one or more of the following conditions exist:
    • Pregnancy or suspicion of pregnancy, abnormalities of the uterus resulting in distortion of the uterine cavity, acute pelvic inflammatory disease (PID), postpartum or postabortal endometritis in the past 3 months, known or suspected uterine or cervical malignancy, uterine bleeding of unknown etiology, untreated acute cervicitis or vaginitis or other lower genital tract infection, conditions associated with increased susceptibility to pelvic infections, Wilson’s disease, a previously placed IUS that has not been removed, hypersensitivity to any component of Paragard including to copper or any of the trace elements present in the copper component of Paragard.

INDICATIONS AND USAGE

Paragard is a copper-containing intrauterine system (IUS) indicated for prevention of pregnancy in females of reproductive potential for up to 10 years.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

  • The use of Paragard is contraindicated when one or more of the following conditions exist:
    • Pregnancy or suspicion of pregnancy, abnormalities of the uterus resulting in distortion of the uterine cavity, acute pelvic inflammatory disease (PID), postpartum or postabortal endometritis in the past 3 months, known or suspected uterine or cervical malignancy, uterine bleeding of unknown etiology, untreated acute cervicitis or vaginitis or other lower genital tract infection, conditions associated with increased susceptibility to pelvic infections, Wilson’s disease, a previously placed IUS that has not been removed, hypersensitivity to any component of Paragard including to copper or any of the trace elements present in the copper component of Paragard.

WARNINGS AND PRECAUTIONS

  • Ectopic Pregnancy: Evaluate for possible ectopic pregnancy in any female who becomes pregnant while using Paragard.
  • Intrauterine Pregnancy: Failure to remove Paragard increases the risk of miscarriage, sepsis, premature labor, and premature delivery.
  • Sepsis: Severe infection or sepsis, including Group A Streptococcal Sepsis (GAS), have been reported following insertion of IUSs, including Paragard.
  • Pelvic Inflammatory Disease and Endometritis: Remove Paragard in cases of recurrent PID or endometritis, or if an acute pelvic infection is severe or does not respond to treatment.
  • Embedment: Partial penetration or embedment of Paragard in the myometrium can make removal difficult; surgical removal may be necessary. Breakage of an embedded Paragard during non-surgical removal has been reported.
  • Perforation: Partial or total perforation of the uterine wall or cervix may reduce contraceptive efficacy and result in pregnancy. Delayed detection or removal of Paragard may result in migration outside the uterine cavity, adhesions, peritonitis, intestinal penetration, intestinal obstruction, abscesses and/or damage to adjacent organs. Increased risk when the uterus is fixed, retroverted or not completely involuted during the postpartum period. If perforation does occur, locate and remove Paragard promptly.
  • Expulsion: Partial or complete expulsion of Paragard has been reported, resulting in the loss of contraceptive protection. The risk of expulsion may be increased when the uterus is not completely involuted at the time of insertion. Remove a partially expelled Paragard.
  • Wilson’s Disease: Paragard may exacerbate Wilson’s disease.
  • Bleeding Pattern Alterations: Paragard can alter the bleeding pattern and result in heavier and longer menstrual cycles with intermenstrual spotting.
  • Magnetic Resonance Imaging (MRI) Safety Information: Non-clinical testing has demonstrated that Paragard is MR Conditional.
  • Medical Diathermy: Avoid using high medical RF transmitter devices in females with Paragard.

ADVERSE REACTIONS

  • Adverse reactions reported in clinical trials include anemia, backache, dysmenorrhea, dyspareunia, expulsion (complete or partial), prolonged menstrual flow, menstrual spotting, pain and cramping, and vaginitis.

INDICATIONS AND USAGE

Paragard is a copper-containing intrauterine system (IUS) indicated for prevention of pregnancy in females of reproductive potential for up to 10 years.

Please see full Prescribing Information for Paragard and Paragard | Single-Hand Inserter.

Reference:
1. Sutton K. The essential guide to LARC coding webinar handout. Webinar presented: https://live.blueskybroadcast.com/bsb/client/CL_DEFAULT.asp?Client=490885&P CAT=2791&CAT=10361. Published March 24, 2016. Accessed August 9, 2017.