CPT® Code – 59400
Short Description – Obstetrical care (antepartum, delivery, and postpartum care)
What does global (total) obstetrical care include?
Global obstetrical (OB) care (CPT® code 59400) includes:
• Routine prenatal care in any trimester
• Delivery
• Postpartum care
Natural deliveries
For all natural deliveries for a client equal to or over 39 weeks gestation, bill using EPA #870001378. For a natural delivery before 39 weeks, use EPA #870001375.
CPT® Code – 59400, 59409, 59410
MEDICAID FEE-FOR-SERVICE PROCEDURES
A. PRENATAL CARE
Prior to enrollment in the MCO, pregnant women and select populations ineligible for enrollment in HealthChoice, may access care on a “fee-for-service” basis.
PROCEDURES
The Medicaid Program does not reimburse physicians for “global” maternity care services. Maryland Medicaid does not use CPT codes 59400, 59510 and 59610. Providers must bill deliveries separately from prenatal care. This is discussed in section “B” under Maternity and Postpartum Services.
Obstetrical Billing Guidelines Services included in the Global OB CPT®’ Code 59400
(Vaginal delivery) or 59510 (Cesarean delivery)
Note:
• The following information is applicable to Plans with maternity benefits.
• Maternity care is subject to a one-time office visit copayment. For BCBS plans with a copayment, this copayment should be collected at the time of the initial OB office visit.
• Physicians will be reimbursed for the initial OB visit separately from the “global maternity care” and should submit a claim for this service at the time of the initial OB visit. Claims should include expected delivery date. All subsequent office visits for maternity care and delivery are considered as part of the “global maternity care” reimbursement. Submit claim upon delivery.
Code amniocentesis separately from the global delivery code. Amniocentesis is not included in the Global CPT codes of 59400 (Vaginal delivery) or 59510 (Cesarea delivery).
Ultrasounds Code separately from the global delivery code. Ultrasounds are not included in the Global CPT codes of 59400 (Vaginal delivery) or 59510 (Cesarean delivery)
• Use the appropriate vaginal delivery code (usually 59400 or 59610) for the first newborn.
• The primary procedure will be allowed at 100% of the contracted rate, subject to the member’s contract benefits.
Maternity care is defined as beginning with the initial visit, and ending with the release of care six weeks after delivery. There are four types of global delivery charges established by CPT:
- Vaginal delivery (59400)
- Cesarean delivery (59510)
- Vaginal delivery after a previous Cesarean delivery (59610)
- Cesarean delivery after failed vaginal delivery attempt after a previous Cesarean delivery (59618)
Vaginal Delivery Reporting
• Primary delivery service code: 59400 or 59610
• Each additional delivery code: 59409-51 or 59612-51
• If the additional service becomes a cesarean delivery, then report the primary delivery service as a cesarean delivery: 59510 or 59618
59400 – Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
Services Included in the Global OB Package
Per CPT guidelines and the American Congress of Obstetricians and Gynecologists (ACOG), the following services are included in the global OB package (CPT codes 59400, 59510, 59610, 59618) Per ACOG coding guidelines, reporting of third- and fourth-degree lacerations should be identified by appending modifier 22 to the global OB code (CPT codes 59400 and 59610) or delivery only code (CPT codes 59409, 59410, 59612 and 59614). Claims submitted with modifier 22 must include medical record documentation that supports the use of the modifier; please refer to the Increased Procedural Services section of this policy and UnitedHealthcare’s “Increased Procedural Services Policy
Services Excluded from the Global OB Package
Per CPT guidelines and ACOG, the following services are excluded from the global OB package (CPT codes 59400, 59510, 59610, 59618) and may be reported separately if warranted
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