Wiki Antepartum Visits

[skrichards26]

What is the correct procedure code/modifier that is needed to bill MEDICAID patients for antepartum visits?

 

[Leandra]

It depends on how many visits there were: 1 - 3 bill appropriate E&M; 4-6 bill 59425; 7-13 bill 59426. Also may depend on what state you live in. I bill Michigan Medicaid and don't use any modifiers on the prenatal visits when I bill them separate from the delivery/post partum visit. I make sure to add the LMP when billing prenatal visits too.

 

[skrichards26]

Thank you Leandra, I am actually located on St Croix US Virgin Islands. I was thinking about contact our local medicaid office but was informed that they no nothing about coding at all. thank you again

 

[YBYERS]

In the state of Washington we use the same CPT codes as above but are required to use the modifier TH when not billing global for DSHS

 

[renewongdoolittle]

medicaid procedure code

We use procedure code H1001,TG for inital visit and H1000 for normal antepartum and H1001 for high risk visits with a V22.1 or V 22.0 code. Medicare only pays for 10 visits for a normal pregnancy and 12 for high risk. There is no global package because the visits are paid individually. If the allowed amount of visits are exceeded, Medicaid will not pay for the visits and they will have to be written off. I hope this is helpful.

 

[Korbc]

do places charge the h1000 instead of the 0500F? and for instance 0500F and 0502F are not charges and we don't charge for them as we go and then count all those visits when they delivery and then charge out a global delivery charge depending on if they have enough visits.......so is h1000 a no charge as well?

 

[nielynco]

Thank you Leandra, I am actually located on St Croix US Virgin Islands. I was thinking about contact our local medicaid office but was informed that they no nothing about coding at all. thank you again

Have you tried accessing their user guide? https://www.vimmis.com/User Guides/USVI Health PAS-OnLine User Guide.pdf

I did notice that the patient must be seen in an FQHC or or health clinic on the VI so you might also want to access the documents for FQHC coding for obstetrics.

 

[nielynco]

do places charge the h1000 instead of the 0500F? and for instance 0500F and 0502F are not charges and we don't charge for them as we go and then count all those visits when they delivery and then charge out a global delivery charge depending on if they have enough visits.......so is h1000 a no charge as well?

Yes, usually the H code are for risk assessment with no payment attached, just for information.

 

[Korbc]

Yes, usually the H code are for risk assessment with no payment attached, just for information.

you are my hero as usual!