MOMS Physican
MOMS Physican
(Referral arrangement with HSS - enter Specialty Code 159 on claim)
| Procedure Code |
Description | Maximum Fee |
|---|---|---|
| * Providers should bill the appropriate code after all antepartum care has been rendered using the last antepartum visit as the date of service. See example claim form. | ||
| 59400 | Routine obstetric care, including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and (inpatient and outpatient) postpartum care (total, all-inclusive, "global" care). | 1,440 |
| 59409 | Vaginal delivery only (with or without episiotomy, and/or forceps); (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum visits *). | 883 |
| 59410 | Including (inpatient and outpatient) postpartum care | 960 |
| 59425* | Antepartum care only; 4 - 6 visits (includes reimbursement for one initial antepartum encounter ($69.00) and five subsequent encounters ($59.00). If less than 6 antepartum encounters were provided, adjust the amount charged accordingly).* | 364 |
| 59426* | Antepartum care only; 7 or more visits (includes reimbursement for one initial antepartum encounter ($69.00) and eight subsequent encounters ($59.00). If less than 9 antepartum encounters were provided, adjust the amount charged accordingly. For 6 or less antepartum encounters, see code 59425.) | 541 |
| 59430 | Postpartum care only (outpatient) (separate procedure) | 59 |
| 59610 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and (inpatient and outpatient) postpartum care, after previous cesarean delivery (total, all-inclusive, "global" care) | 1,440 |
| 59612 | Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum care visits | 883 |
| 59614 | including (inpatient and outpatient) postpartum care | 960 |
Cesarean Section
| Procedure Code |
Description | Maximum Fee |
|---|---|---|
| * NOTE: Inpatient hospital (E/M codes) visits should not be billed with MOMS speciality code 159. Bill vists on a seperate claim with the appropriate physician specialty code. | ||
| 59510 | Routine obstetric care including antepartum care, cesarean delivery, and (inpatient and outpatient) postpartum care (total, all-inclusive, "global" care) | 1,440 |
| 59514 | Cesarean delivery only; (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum visits *). | 883 |
| 59515 | Including (inpatient and outpatient) postpartum care | 960 |
| 59618 | Routine obstetric care including antepartum care, cesarean delivery, and (inpatient and outpatient) postpartum care, following attempted vaginal delivery after previous cesarean delivery (total, all-inclusive, "global" care) | 1,440 |
| 59620 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum care visits) | 883 |
| 59622 | including (inpatient and outpatient) postpartum care | 960 |
Other Procedures and Tests
| Procedure Code |
Description | Maximum Fee |
|---|---|---|
| * NOTE: The above-listed ultrasound codes can be billed with professional component modifier 26. Reimbursement will not exceed 40% of maximum fee for procedure. The ordering/referring provider’s Name and Medicaid ID number or License Number and License Type are required on the claim when billing for ultrasound procedures. New ultrasound procedure codes updated on 07/01/03 are identified in BOLD type. |
||
| 59025 | Fetal non-stress test (in office, cannot be billed with professional component modifier 26) | 70 |
| 76801 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester, (<14 weeks 0 days), transabdominal approach (complete fetal and maternal evaluation); single or first gestation | 174 |
| 76802 | each additional gestation (List separately in addition to code for primary procedure) (Use 76802 in conjunction with code 76801 | 136 |
| 76805 | Ultrasound, pregnant uterus, B-scan and/or real time with image documentation: complete (complete fetal and maternal evaluation) | 174 |
| 76810 | Complete fetal and maternal evaluation, multiple gestation, AFT | 174 |
| 76811 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach (complete fetal and maternal evaluation): single or first gestation | 241 |
| 76812 | each additional gestation (list separately in addition to code for primary procedure) (Use 76812 in conjunction with 76811) | 120 |
| 76815 | Limited (fetal size, heartbeat, placental location, fetal position, or emergency in the delivery room) | 116 |
| 76816 | Follow-up or repeat | 97 |
| 76817 | Ultrasound, pregnant uterus, real time with image documentation, transvaginal | 190 |
| 76818 | Fetal biophysical profile; with non-stress testing | 135 |
| 76819 | Fetal biophysical profile; without non-stress testing | 135 |
MOMS Physican
Prenatal Care contractor - enter Specialty Code 159 on claim
| Procedure Code |
Description | Maximum Fee |
|---|---|---|
| * NOTE: Inpatient hospital visits should not be billed with MOMS specialty code 159. Bill visits (E/M codes) on a separate claim with the appropriate physician specialty code (e.g. 089 — Obstetrics and Gynecology, or 050 — Family Practice). | ||
| 59409 | Vaginal delivery only (with or without episiotomy, and/or forceps); (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum care visits *). | 883 |
| 59612 | Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum care visits. | 883 |
| 59514 | Cesarean delivery only; (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum care visits *). | 883 |
| 59620 | Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery; (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum care visits) | 883 |
MOMS Physican Licensed Midwife
(Referral arrangement with HSS
Category of Service of 0525 - Speciality Code 159 on file; and must be entered on claim)
| Procedure Code |
Description | Maximum Fee |
|---|---|---|
| * Providers should bill the appropriate code after all antepartum care has been rendered using the last antepartum visit as the date of service. NOTE: Hospital E/M codes cannot be billed with specialty code 159. A separate claim must be submitted if billing for inpatient hospital visits. |
||
| 59400 | Routine obstetric care, including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and (inpatient and outpatient) postpartum care (total, all-inclusive, "global" care) | 1,440 |
| 59409 | Vaginal delivery only (with or without episiotomy, and/or forceps); (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M Code(s) for postpartum care visits*) | 883 |
| 59410 | including (inpatient and outpatient) postpartum care | 960 |
| 594258* | Antepartum care only; 4-6 visits (includes reimbursement for one initial antepartum encounter ($69.00) and five subsequent encounters ($59.00). If less than 6 antepartum encounters were provided, adjust the amount charged accordingly). | 364 |
| 59426* | Antepartum care only; 7 or more visits (includes reimbursement for one initial antepartum encounter ($69.00) and eight subsequent encounters ($59.00). If less than 9 antepartum encounters were provided, adjust the amount charged accordingly. For 6 or less antepartum encounters, see code 59425.) | 541 |
| 59430 | Postpartum care only (outpatient) (separate procedure) | 59 |
| 59610 | Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and (inpatient and outpatient) postpartum care, after previous cesarean delivery (total, all-inclusive, "global" care) | 1,440 |
| 59612 | Vaginal delivery only; after previous cesarean delivery (with or without episiotomy and/or forceps); (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum care visits) | 883 |
| 59614 | including (inpatient and outpatient) postpartum care | 960 |
MOMS Physican Licensed Midwife
(Referral arrangement with HSS - enter Speciality Code 159 on claim)
Other Procedures and Tests
| Procedure Code |
Description | Maximum Fee |
|---|---|---|
| 59025 | Fetal non-stress test (in office, cannot be billed with professional component modifier 26) | 70 |
MOMS Physican Licensed Midwife
Prenatal Care contractor
Category of Service 0525 - Speciality Code 159 on file; and must be entered on claim)
Other Procedures and Tests
| Procedure Code |
Description | Maximum Fee |
|---|---|---|
| NOTE: Hospital E/M codes cannot be billed with specialty code 159. A separate claim must be submitted if billing for inpatient hospital visits. | ||
| 59409 | Vaginal delivery only (with or without episiotomy, and/or forceps); (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M Code(s) for postpartum care visits*) | 883 |
| 59612 | Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps); (when only inpatient postpartum care is provided in addition to delivery, see appropriate HOSPITAL E/M code(s) for postpartum care visits. | 883 |
MOMS Nurse Practitioner
(Referral arrangement with HSS)
Category of Service 0469 - Speciality Code 159 on file; and must be entered on claim)
Other Procedures and Tests
| Procedure Code |
Description | Maximum Fee |
|---|---|---|
| Providers should bill the appropriate code after all antepartum care has been rendered using the last antepartum visit as the date of service. | ||
| 59425* | Antepartum care only; 4-6 visits (includes reimbursement for one initial antepartum encounter ($69.00) and five subsequent encounters ($59.00). If less than 6 antepartum encounters were provided, adjust the amount charged accordingly). | 364 |
| 59426* | Antepartum care only; 7 or more visits (includes reimbursement for one initial antepartum encounter ($69.00) and eight subsequent encounters ($59.00). If less than 9 antepartum encounters were provided, adjust the amount charged accordingly. For 6 or less antepartum encounters, see code 59425.) | 541 |
| 59430 | Postpartum care only (outpatient) (separate procedure) | 59 |
