Billing Guidelines for Maternity Services
To help to ensure that submitted claims are quickly and accurately processed, we’d like to remind you of the appropriate billing procedures for routine maternity services provided to our enrolled members. We do understand that there are numerous situations and complications may occur while providing maternity care to your patients, but in the interest of clarity and simplicity, here we’ll be considering a routine pregnancy handled by a single obstetrical provider/group practice.
Obstetrical providers that bill on a global basis should submit a single claim for all services rendered during the maternity period (the 270-day term of a covered person’s pregnancy for antepartum care, delivery and postpartum care). It is appropriate to bill one of the following global CPT codes once for all services rendered during the maternity period of a particular patient.
| 59400 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care. |
| 59510 | Routine obstetric care, including antepartum care, cesarean delivery, and postpartum care. |
| 59610 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery. |
| 59618 | Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery. |
When you bill on a global basis for the care provided to an enrolled Horizon BCBSNJ member during a single maternity period, please keep the following guidelines in mind.
- DO NOT submit multiple global codes for the same pregnancy.
- DO NOT bill separately for maternity components.
- DO NOT bill separately for a delivery charge.
- DO NOT bill multiple global codes for multiple births:
- For multiple vaginal births:
- - Bill the appropriate global code for the initial child and
- - Bill a vaginal delivery-only code appended with modifier 59 for each subsequent child.
- For a cesarean birth following a vaginal birth:
- - Bill the appropriate global code for the initial child and
- - Bill a cesarean delivery-only code appended with modifier 51 should be billed for each subsequent child.
- For multiple cesarean births.
- - If there is increased physician work involvement for delivery of subsequent babies, please append the global cesarean code with modifier 22. Medical record documentation, that supports the use of this modifier, should be included.
- For multiple vaginal births:
If you have questions, please contact your Network Specialist.