Wiki OB care Split billing to BCBS SC

[CBR11]

Wondering if anyone else is having difficulty with BCBS SC when billing for OB care CPT's 59425 or 59426. I have a couple OB care claims that have been denied by BCBS SC. (Denial included in Global) each time the delivery was billed 59410. The scenario: Patient's insurance changed during pregnancy resulting in need to split bill for OB care. We have appealed the denials with records and still the denial is upheld. Does BCBS SC require specific Modifier on the OB care claim. I have looked in the SC billing manual and there is not mention of a required modifier.

 

[beulastella]

If the patient switched from Insurer A → BCBS SC mid-pregnancy, use:

Coverage Period	Code	Details
Under Insurer A	59425 / 59426	Depending on number of visits seen before change
Under BCBS SC	59425 / 59426	With proper date span documented
Delivery + Postpartum	59410	Billed separately at delivery to BCBS SC

Do not append extra modifiers (like UA or modifier 59) unless guided by ACOG or other payers. BCBS does not require modifiers for these codes