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Billing for Midwives

  1. #1
    Daytona Beach, FL
    Question Billing for Midwives
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    I need some help in coding for a midwife. Our group practice has just aquired an OB group and they have Nurse Midwives who are part of the practice. Can anyone tell me how we are to bill for their services? Do we bill separately under their own NPI or under the physician? And do we need to use any modifiers for these services? As far as I know the Midwives see only the OB patients - but if they also see GYN patients, how would we bill that too?

    Any help and guidance would be greatly appreciated as this is completely new to me!

    Jodi Dibble, CPC

  2. Default
    We only bill for midwives, so let's see if I can shed some light on the subject.

    First, contracts. I'm assuming the OBs are contracted, but are the CNMs? There are still some archaic state laws requiring midwives to work under the direct supervision of a physician and everything must be billed under the doc's numbers. There are still some insureres that require the same, too, so you will need to know this information. A review of the contracts and/or a phone call to your insurance rep should clear up this matter.

    If you can bill directly for the midwives (the best way, IMHO) using their NPI, the billing/coding is the same as for an OB. There are some Medicaid plans that require a modifier, but not any commercial carriers that I am aware of.

    GYN billing is also the same. CNMs are a federally mandated provider with Medicare and Medicaid, so I would think these services could be billed to them directly, but--again--check the contract or call your insurance rep. Also, CNMs were reimbursed at 65% of the Medicare physician's fee schedule, but the new Healthcare laws changed that to 100%. Because of the 65% rule, many offices billed midwifery services under the physician's numbers as a matter of course in order to receive the full reimbursement.

    There is a nationwide effort to allow midwives to bill independent of a physician and states are slowly changing their laws accordingly. If you can bill with the midwives' numbers, I encourage you to do so. It raises the awareness of the work of midwives within the insurance industry, and when office reports are run, it is easier to see their financial contribution.

    ~Kelli Sugihara
    Midwife Billing & Business, LLC
    (daughter of a midwife--yes, I'm partial!)

  3. #3
    Daytona Beach, FL
    Thanks Kelli for your response. This will help - we will check their contracts and contact the insurances to check how we should bill!
    Jodi Dibble, CPC

  4. Default
    Good Morning Kelli;
    I am also researching to see how midwifes are paid. Is this information you posted still correct?
    Thank you so much.

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