EA Codes for Contraceptives - Washington State Local Health Insurance - CHPW

EA Codes for Contraceptives

Effective 6/1/2022, all Apple Health contracted managed care (MCO) and fee-for-service (FFS) plans have added expedited authorization (EA) criteria for contraceptives.

An EA code will be required on all claims for contraceptives. The EA code will allow pharmacies to submit a claim for contraceptives based on the following criteria.

Product EA code Code criteria
Contraceptives 85000000131 Used as a contraceptive, dispense 1 year
Contraceptives 85000000132 Used as a contraceptive, dispensed less than a twelve month supply due to ONE of the following:

  • The prescriber is unwilling to change dispensed quantity to twelve-month supply
  • The patient does not want twelve-month supply
  • The pharmacy does not have adequate stock
Contraceptives 85000000133 Used for other diagnosis, not related to contraception up to a 90-day supply.

 

For additional questions, email: [email protected] or call Community Health Plan Customer Service at 1-800-440-1561 Monday through Friday 8:00 am to 5:00 pm.

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