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Wyoming Medicaid Improves Maternity Coverage for Obstetrical and Pediatric ProvidersEffective July 1st.
Maternity care is a priority at Wyoming Medicaid. Pregnant and postpartum women comprise a significant segment of our beneficiaries and we cover approximately 30% of births in Wyoming. We are disturbed by the declining trend among maternal outcomes at a state and national level. With this in mind, we reviewed our current benefits with clinical and fiscal input with an aim to better meet the needs of our clients and providers.
In the prenatal period, we are increasing reimbursement of our diagnosis of pregnancy code 0500F to obstetrical providers to $100. This may be billed once a pregnancy and will be reimbursed in addition to the bundled payment for the pregnancy. By coding this universally and in a timely manner, Medicaid’s WYHealth health management program and our partners atpublic health nursing and WIC can engage and perform outreach to your patients. We envision this will provide an expanded network of support and services for pregnant women in the program. Please let your pregnant patients know to expect the outreach and encourage them to participate!
Additionally, we will be reimbursing pediatric providers to perform prenatal visits with expecting parents. Such visits are recommended by the AAP, particularly for those who are single, first-time parents or of low-income status. Important topics addressed at such visits include breastfeeding, immunizations, well baby visit schedule, safety and positive parenting.Pediatric providers may bill using CPT G9001 along with ICD-10 Z76.81. This will be reimbursed once per pregnancy.
In the postpartum period, we will be reimbursing postpartum visits with obstetrical providers during the 45-day postpartum billing period outside of the pregnancy bundle. We have also removed limits on the number of postpartum visits. We hope postpartum women will at least receive 2 of these visits as recommended by ACOG.
Last, we would like to remind both pediatric and obstetrical providers that Wyoming Medicaid reimburses for postpartum depression screening during postpartum and well-baby visits. The AAP recommends postpartum mothers be screened at 1-, 2-, 4- and 6-month well-baby visits. Validated screening instruments such as the Edinburgh Postpartum Depression Scale and the PHQ-2 or PHQ-9 can be used. Obstetrical providers may bill with the code 96160 and pediatric providers with the code 96161 .
We very much appreciate your care for our clients and their families. Please do not hesitate to reach out with concerns or suggestions for improvement.
Best,
Paul
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