When your office has provided global maternity care for a member who has been effective with MHP for nine months or longer, please bill with the appropriate global maternity code:
59400 Routine obstetrical care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care; or
59510 Routine obstetrical care including antepartum care, cesarean delivery, and postpartum care.
These codes include reimbursement for the following services:
Prenatal care (office visits by physician or one or more partners);
Lab work related to pregnancy - venipunctures and urinalysis only;
Delivery (vaginal or cesarean);
Post-partum hospital visits; and
Post-partum office visits (anytime during the 6 weeks following delivery).
These codes do not include reimbursement for physician hospital visits made when a member is hospitalized for preterm labor. Separate payment is remitted for those services.
When the member has been effective less than nine months and your office has provided maternity services in the prenatal through the postpartum periods, please submit your claims in the following manner:
Ten visits or more: Global Maternity code with the number '1' in the 'Units' field of the CMS 1500;
Less than 10 visits:
1-3 Visits: Appropriate E&M code with your usual charge noted for each service;
4-6 Visits: 59425 with a start date and an end date and your usual charge for the service; or
7 or More: 59426 with a start date and an end date, and your usual charge for the service, and a separate line with charges for delivery 59409 or 59410 (vaginal); or 59514 or 59515 (cesarean.)
When your office has provided prenatal/antepartum care only, please bill using 59426 with the appropriate start and end dates and your usual charge for the service provided.
When your office has provided delivery only or delivery and postpartum care, please bill using 59409, 59410, 59514 or 59515 and your usual charge for these specific services.