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Pennsylvania Medicaid OB modifiers

  1. #1
    Default Pennsylvania Medicaid OB modifiers
    Medical Coding Books
    Good Morning! I am hoping to get some help with PA Medicaid modifiers for OB patients. Can someone please tell me what modifiers I need to use for Gateway, Amerihealth Mercy, United Health Care Community Plan and plain old Medicaid for routine prenatal visits and also for the deliveries. I seem to get alot of rejections because of these "invalid modifiers" and I can't get a straight answer from my reps!! Please help!

  2. Default modifiers
    Medicaid always has exceptions to all of their rules. When billing prenatal office visits - use the TH modifier for MA, the U9 modifier for Gateway. UHC does not like any modifiers and will deny a claim if you use a TH on a prenatal visit. We are not par with Aetna Better Health but have submitted as nonpar and have used the TH modifier. If the Medicaid patient has HCB15 - select plan for women - you need to use the FP modifier or they will reject your gyn visits. Hope this info helps.

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