California Business and Professions Code §4052.3. Authorizes a pharmacist to furnish self-administered hormonal contraceptives in accordance with a protocol approved by the California State Board of Pharmacy and the Medical Board of California.
Eligible Medications: Contraceptive pills, patches, and vaginal rings, and depot injections.
Prescription Limitations: Up to 12 months of refills. Follow-up required after two years.
Age Restrictions: No specific age requirement, but pharmacists must screen patients using USMEC guidelines.
Documentation Requirements: Maintain patient records for 3 years; comply with HIPAA regulations.
Training Requirements: Completion of state-mandated courses for prescribing and patient counseling. Pharmacists must complete a minimum of one hour of board-approved continuing education on self-administered hormonal contraception, USMEC application, and CDC guidance.
Reimbursement Details
Eligibility
Pharmacies wishing to be reimbursed must be enrolled in Medi-Cal and CalOptima Health. In addition, each pharmacist must also register as an Ordering, Referring, and Prescribing (ORP) provider.
Billing Codes
99202 (New Patient): Covers furnishing naloxone, self-administered hormonal contraception, NRT, travel medications, PrEP/PEP, and vaccinations.
99212 (Established Patient): Same coverage as 99202.
Billing restrictions: CPT 99212 is limited to 6 visits
per 90 days per patient. More visits require medical justification.
Submission Process
Claims must be submitted using the CMS-1500 form or electronically via ASC X12N 837P v.5010 transaction. (Use correct place-of-service codes as outlined by CMS and Medi-Cal.)
Reimbursement is set at 85% of the Medi-Cal physician fee schedule
Verify patient eligibility for Medi-Cal benefits on the date of service.
