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TO: Maternity Care Providers
Effective
immediately, payment will be denied for all global maternity delivery and
postpartum codes filed as an emergency. Additionally, the Agency will recoup
previous reimbursement for these codes filed as an emergency.
Providers should not bill global delivery codes as emergency services.
An emergency maternity service is the delivery only (i.e., the emergency
management of an impending delivery). It does not include prenatal care,
postpartum care, or other maternity related services. During these types of
emergencies, it is appropriate to bill delivery only codes (vaginal or
cesarean) but not the global maternity or postpartum codes. Eligible CPT Codes for
deliveries, when provided as an emergency service, are limited to the
following:
CPT Procedure Code
|
Procedure Code Description
|
59409
|
Vaginal
delivery only
|
59514
|
Cesarean
delivery only
|
59612
|
Vaginal
delivery only, after previous cesarean
|
59620
|
Cesarean
delivery only, following attempted vaginal delivery after previous cesarean
delivery
|
For questions, please visit www.medicaid.alabama.gov
or call the Medicaid Fiscal Agent at
1-800-688-7989.