Medication abortion using mifepristone and misoprostol involves 2 office visits, lab tests, ultrasounds, and administration of medication. The following codes can be used when providing these services:
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Visit 1
Includes verification of pregnancy and pregnancy date, counseling of the patient, and administration of mifepristone,
Diagnosis code 635.92 (legally induced abortion, without mention of complication, complete). Please check ICD-9 manual for other codes for abortion with complications). Five-digit diagnosis code needed.
99204 or 99214 (level 4 new or established patient E/M visit)
J8499 (prescription drug, oral, nonchemo, not otherwise specified) or
J3490 (unclassified drug). If J codes are not accepted by insurance carrier, use 99070 (a cost of materials CPT code) or S0190 for Mifepristone. Each insurance carrier may reimburse for mifepristone using a different code. The name of the drug (mifepristone), the dosage (200 mg.), and the 11-digit national drug code (NDC) from the drug package must accompany this claim. In addition, submit a copy of the drug invoice to show the cost of the drug.
76817 (transvaginal ultrasound, pregnant uterus) or 76815 (limited ultrasound, pregnant uterus)
In addition, submit codes for appropriate lab tests or Micro Rhogham (90385) if done in office.
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Visit 2
Verifies that the pregnancy has ended.
Diagnosis code 635.92
99213 or 99214 (level 3 or 4 E/M visit for established patient)
76817 or 76815 (ultrasound)
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Additional information about coding for medication abortion
Detailed information about coding issues in your state can be found at the Danco website
