October 15, 2024

Submitting Prenatal and Postpartum Service Claims for Each Pregnancy Related Visit

Dear Provider:

This communication is applicable for providers who offer perinatal services:

• OB/GYNs
• Midwives
• Family Practice Providers
• Outpatient Clinics that provide OB/GYN services

To better understand the timing and delivery of perinatal (prenatal and postpartum) services to New York State (NYS) Medicaid members and Medicaid Managed Care (MMC) enrollees, additional information is needed from NYS Medicaid providers. Effective for service delivered as of July 1, 2024, providers using bundled/global procedure codes for billing will also be required to submit claims with non-payment Category II Current Procedural Terminology (CPT) codes for perinatal services to NYS Medicaid fee-for-service (FFS) and MMC. The bundled/global bill procedure codes are: 59400, 59410, 59510, 59515, 59610, 59614, 59618, 59622, 59426, and 59425.

Effective July 1, 2024, providers are required to submit a claim with a Category II CPT code for each prenatal/postpartum service provided to a NYS Medicaid member when the provider is billing using the global bill codes or a bundled bill. These Category II CPT code claims are in addition to the global or bundled code claims. Claims for NYS Medicaid FFS members must be submitted directly to NYS Medicaid. Claims for MMC enrollees must be submitted to the MMC Plan of the enrollee. Additionally, the following Category II CPT codes must be used:  

MMC Plans are required to submit this information, alongside other encounter data, to NYS Medicaid via the Original Source Data Submitter (OSDS) system

If you have any questions regarding this communication, please direct them to: MaternalandChild.HealthPolicy@health.ny.org or call Amida Care at Claims Department: 800-556-0674.