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Payer Coverage Reimbursement Other
Aetna US Healthcare Mifeprex is covered to the same extent as surgical abortions. Reimbursement for a patient's non-primary care physician uses E/M codes for office visits; the drug is reimbursed using code J3490 and is paid based on the physician's invoice cost. If the patient's primary care physician is providing Mifeprex and s/he is capitated, the office visits are under the capitation. The drug cost is reimbursed separately based on the invoice cost. OB/GYNS will not need a referral to provide Mifeprex to their patients. If an internist or family practice physician is providing Mifeprex but s/he is not the primary care provider for the patient, a referral will be needed.
Blue Cross and Blue Shield of Vermont Mifeprex is covered to the same extent as surgical abortions. Reimbursement for the office visits uses E/M codes. The drugs are reimbursed using either J3490 or J8499. All other services are reimbursed separately, if medically necessary

Vermont State Medicaid Information

Agency of Human Services of Vermont
103 South Main Street
Waterbury, VT 05676-1201
Local: 1-802-879-5900
Toll free: In-State Calls Only 1-800-250-8427
TTY: 1-802-241-1282
www.ovha.state.vt.us