Minnesota Family Planning Program (MFPP) Procedure Codes
00840
00851
00920
00921
00950
00952
11976
11981
49320
49321
49329
52010
54500
54505
54865
54830
54900
54901
55200
55250
55300
55400
55450
55520
55530
55535
55540
55600
55605
55680
55870
57160
57170
57410
57505
57700
57720
57800
58100
58120
Anesth, surg low abdmn
Anesth, tubal lig/transect
Anesth, genitalia surgery
Anesth, vasectomy
Anesth, vaginal endoscopy
Anesth, uterine endoscopy
Removal of contracep cap
Insert drug implant device
Diag laparo separate proc
Laparoscopy, biopsy
Lap proc, abdm/per/omentum
Cystoscopy & duct catheter
Biopsy of testis, needle
Biopsy of testis, incis
Exploration of epididymis
Excision epididymis lesion
Fuse sperm ducts, unilateral
Fuse sperm ducts, bilateral
Vas cannul w/wo incis
Vas, uni/bilat postop semen exam
Prep for sperm duct x-ray
Repair sperm duct
Ligation sperm duct
Excis sperm cord lesion
Revise sperm cord veins
Revise sperm cord veins abd
Excis hernia & sperm veins
Vesiculotomy
Vesiculotomy; complicated
Excis Mullerian duct cyst
Electroejaculation
Insert pessary sup device
Fit diaphragm/cap
Pelvic exam under anesth
Endocervical curettage
Revision of cervix
plastic repair cervix
Dilation of cervical canal
Biopsy uterus lining
Dilation & curettage
Minnesota Family Planning Program (MFPP) Procedure Codes
58140
58145
58300
58301
58340
58345
58350
58400
58540
58555
58558
58559
58560
58561
58565
58600
58605
58611
58615
58660
58670
58671
58672
58673
58700
58740
58752
58760
58770
58825
58900
58920
74000
74740
74742
76856
76857
76870
76872
76948
Myomectomy abd approach
Myomectomy vag approach
Insertion IUD
Remove IUD
Inject for ut/tube x-ray
Reopen fallopian tube
Chromotubation oviduct
Uterine suspension
Hyseroplasty, (Strassman)
Hysteroscopy, diagnostic
Hysteroscopy, biopsy
Hysteroscopy, lysis
Hysteroscopy resect septum
Hysteroscopy remove myoma
Hysteroscopy bi tube cannul
Ligate/transect tubal, ab/vag
Lig/tran tubal uni/bi postpart same stay
Ligation oviduct(s)
Fal tube occlusion w device
Laparoscopy lysis
Lap w fulg ovid w/wo transect
Lap w occlus ovid by device
Laparoscopy fimbrioplasty
Laparoscopy salpingostomy
Salpingectomy
Lysis of adhesions
Revise ovarian tube(s)
Fimbrioplasty
Salpingostomy
Transposition, ovary(s)
Biopsy of ovary
Wedge resec/bisect ovary uni/bi
Rad exam, abd 1 anteropost
Hysterosalpingography
X-ray fallopian tube
Echography pelvic complete
Echography pelvic
Echography scrotum
Ultrasound transrectal
Echo guide ova aspiration
Minnesota Family Planning Program (MFPP) Procedure Codes
77080
77081
80061
80076
81000
81001
81002
81003
81004
81005
81006
81007
81010
81011
81012
81015
81025
82270
82465
82670
82746
82947
82951
83000
83001
83002
83020
83986
84146
84443
84702
84703
84830
85002
85004
85007
85008
85013
85014
85018
DXA axial
DXA appendicular
Lipid panel
Hepatic function panel
Urinalysis with microscopy
Urinalysis auto w/scope
Urinalysis nonauto no scope
Urinalysis auto w/o scope
Urinalysis Single Compon
Urinalysis qual/semiquan
Urine volume measurement
Urinalysis for bacteriuria
Urinalysis Con & Dilu Test
Urinalysis H2ODep Test
Urine H2O Dp Tst w Vso Rsp
microscopic urine exam
Urine Pregnancy Test
Test feces for blood
Assay serum cholesterol
Estradiol
Folic acid; serum
Assay quantitative glucose
Glucose tolerance test GTT
Gn pituitary FSH bioassay
Gonadotropin FSH
Gonadotropin LH
Hemoglobin assay
pH body fluid assay
Prolactin
TSH
hCG quantitative
hCG qualitative
Ovulation tests
Bleeding time
Automated diff wbc count
Differential WBC count
Nondifferential WBC count
Spun microhematocrit
Hematocrit
Hemoglobin
Minnesota Family Planning Program (MFPP) Procedure Codes
85025
85027
85032
85049
85610
85651
85652
85730
86592
86593
86631
86632
86687
86688
86689
86695
86696
86701
86702
86703
86706
86781
86803
87070
87075
87081
87086
87088
87109
87110
87140
87181
87184
87205
87206
87207
87210
87252
87254
87255
Auto hemogram diff WBC
Auto CBC
Manual cell count each
Automated count platelet
Prothrombin time
Sedimentation rate non-auto
Rbc sed rate, auto
PTT
Blood serology qualitative
Blood serology quantitative
Antibody; Chlamydia
Antibody; Chlamydia, IgM
Antibody; HTLV-I
Antibody; HTLV-II
HTLV/HIV confirm test
Herpes simplex type 1
Herpes simplex type 2
HIV-1
HIV-2
HIV-1/HIV-2 single assay
Hep B surface ab test
Treponema pallidum, confirm
Hep C antibody
Bac cult not urine,bld/stool
Culture bacteria specimen
Culture bacteria screen
Urine cult quan count
Bac cult w isol &ID isolates
Mycoplasma cult
Culture chlamydia
culture typing fluorescent
Antibiotic sensitivity
Antibiotic sensitivity
Smear stain & interpret
Smear stain & interpret
Smear stain & interpret
Smear stain & interpret
Virus inoculate for test
Virus inoculate shell vial
Genet virus isolate, hsv
Minnesota Family Planning Program (MFPP) Procedure Codes
87270
87273
87274
87285
87320
87340
87350
87390
87391
87449
87490
87491
87492
87528
87530
87531
87532
87533
87534
87535
87536
87537
87538
87539
87590
87591
87592
87620
87621
87622
87797
87798
87799
87800
87810
88141
88142
88143
88144
88145
Chylmd trach ag, dfa
Herpes simplex 2, ag, if
Herpes simplex ag, dfa
Influenza b, ag, if
Chylmd trach ag, eia
Hep b surface ag, eia
Infect antigen detect
Infect antigen det HIV-1
Hiv-2 ag, eia
Ag detect nos, eia, mult
Chylmd trach dna dir probe
Chylmd trach dna amp probe
Chylmd trach, dna, quant
Hsv, dna, dir probe
Hsv, dna, quant
Hhv-6, dna, dir probe
Hhv-6, dna, amp probe
Hhv-6, dna, quant
Hiv-1, dna, dir probe
Hiv-1, dna, amp probe
Hiv-1, dna, quant
Hiv-2, dna, dir probe
Hiv-2, dna, amp probe
Hiv-2, dna, quant
N.gonorrhoeae dna dir prob
N.gonorrhoeae dna amp prob
N.gonorrhoeae dna quant
Hpv, dna, dir probe
Hpv, dna, amp probe
Hpv, dna, quant
Detect agnt nos dna dir
Detect agnt nos dna amp
Detect agnt nos dna quant
Detect agnt mult dna direc
Chylmd trach assay w/optic
Cytpath crv/vag interp
Cytpath crv/vag t/layer
Cytpath c/vag t/layer redo
Cytpth c/vag t/layer auto
Cytpth c/vag t/layer selct
Minnesota Family Planning Program (MFPP) Procedure Codes
88147
88148
88150
88151
88152
88153
88154
88155
88156
88157
88158
88160
88161
88162
88164
88165
88166
88167
88174
88175
88300
88302
89300
89321
93975
93976
96372
99078
99201
99202
99203
99204
99205
99211
99212
99213
99214
99215
99241
99242
Cytpath c/vag automated
Cytpath c/vag auto rescrn
Cytopath, pap smear
Cytopath interpret
Cytopath cerv/vag auto
Cytpath c/vag redo
Cytpath c/vag select
Cytopath pap smear
TBS smear Bethesda System
TBS smear Bethesda System
Cytopath cerv/vag tbs auto
Cytopathology
Cytopathology
Extensive cytopathology
Cytpath tbs c/vag manual
Cytpath tbs c/vag redo
Cytpth tbs c/vag auto redo
Cytpath tbs c/vag select
Cytopath c/v auto in fluid
Cytpth c/v auto fluid redo
Level 1 surg path gross only
Lev 2 surg path gross & micro appendix incidental fall tube sterilization
Semen analy; include Huhner test
Semen analysis
Vascular study
Dup scn flw art in&ven out
Ther/proph/diag inj, sc/im
Grp health ed
Office/outpt visit–new pt
Office/outpt visit–new pt
Office/outpt visit–new pt
Office/outpt visit–new pt
Office/outpt visit–new pt
Office/outpt visit–new pt
Office/outpt visit–est pt
Office/outpt visit–est pt
Office/outpt visit–est pt
Office/outpt visit–est pt
Office consultation
Office consultation
Minnesota Family Planning Program (MFPP) Procedure Codes
99243
99244
99245
99384
99385
99386
99394
99395
99396
99401
99402
99403
99404
99411
99412
A4261
A4266
A4267
A4268
A4269
G0027
H1010
J1050
J7300
*J7302
*J7303
*J7304
*J7306
J7307
Q0091
*S4989
*S4993
T1013
Office consultation
Office consultation
Office consultation
Prevent visit new 12-17
Prevent visit new 18–39
Prevent visit new 40–64
Prevent visit est 12-17
Prevent visit est 18–39
Prevent visit est 40–64
Prev counsel indv 15 min
Prev counsel indv 30 min
Prev counsel indv 45 min
Prev counsel indv 60 min
Prev counsel grp 30 min
Prev counsel grp 60 min
Cerv cap contracep
Diaphragm
Male condom
Female condom
Spermicide
Semen analysis pres/mot
Nonmed fam plan ed
Medroxyprogesterone acetate 1mg inject
copper IUD
Levonorgestrel IUD system
Contracept vaginal ring
Contracept patch
Levonorgestrel imp system
Etonogestrel impl system
Pap smear
Contracept IUD
Contracept BC pills
Oral language interp
*Indicates the HCPCS code requires an NDC dispensing unit and the quantity when billing MHCP.
Secondary MFPP Procedure Codes
Code/Range
J0561
*J0696
*J8499**
Description
Inj penicillin G benz to 2.4 mil units
Inj ceftriaxone sodium
Prescription drug, oral, NOS Use to report CDC recommended drugs for treatment of
STIs when dispensed in the office, for example Amoxicillin, Cefixime, Ciprofloxacin,
Clindamycin, Clotrimazole, Doxycycline, Fluconazole, Metronidazole, Nitrofurantoin,
Ofloxacin, Sulfa-methoxazole/Trimethoprim, Terconazole. List the drug, dosage and
number of tablets dispensed in the comments section of the services tab for that
individual service line in MN–ITS
*Q0144
Azithromycin, oral capsule
10060
Incis & drain abscess
10140
Incis & drain hematoma
17110
Wart destruction
54050
Destroy penis lesions, chem
54056
Destroy penis lesions, cryo
56501
Destroy vulva lesions
57061
Destroy vaginal lesions
57452
Colposcopy cervix incl up/adj vagina
57454 - 57456 Colposcopy, w bio cervix
57460 - 57461 Colposcopy, w loop biop cervix conization
57510 - 57511 Cautery of cervix;
88305
Level IV - Surg path, gross and micro
88307
Level V - Surg path, gross and micro
*Indicates the HCPCS code requires an NDC when billing MHCP. Refer to NDC Reporting Clarification for
additional information.
**In addition to the NDC, J8499 continues to require the drug, dosage and number of tablets dispensed in the
comments.