`S4989` Contracept iud

Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for S4989

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S4989

Payer coverage policies that name S4989

S4989 appears in 2 coverage policies from Aetna, Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Progestins (0510)	covered if criteria are met	Jul 13, 2026	payer document
Premera Blue Cross	Preventive Care	covered if criteria are met	Sep 21, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

CO: $115.44 (health_first_colorado), effective Jul 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
OK: $84.00 (physician, non-facility), effective Jul 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Jan 1, 2017

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

S4989 Contracept iud