Delivery, newborn & postpartum services billing
Medicaid patients
Newborn services must be submitted separately from the mother, using the newborn's Medicaid ID number.
- The Medicaid ID number is issued by the State of Michigan, not Priority Health.
- This process may take up to 30-60 days.
- Physician offices may check for a member's eligibility on the State's website.
Delivery only (no prenatal or postpartum care)
Bill newborn facility charges on a separate claim from the mother's charges. Do not combine the newborn and mother's charges in one claim.
Bill delivery immediately after service is rendered.
- Codes: Use 59409, 59514, 59612, and 59620
- From/To dates (Box 24A HCFA): List exact delivery date
- Quantity (Box 24A HCFA 1500): One
- Fill in the EXACT LMP date in box 14 of the HCFA 1500.
Delivery & postpartum care (no prenatal)
Bill newborn facility charges on a separate claim from the mother's charges. Do not combine the newborn and mother's charges in one claim.
Bill delivery and postpartum care after postpartum care has been completed.
- Codes: Use 59410, 59515, 59614, and 59622
- From/To dates (Box 24A HCFA): List exact delivery date
- Quantity (Box 24A HCFA 1500): One
- Fill in the EXACT LMP date in box 14 of the HCFA 1500.
Postpartum care only (no prenatal, no delivery)
Postpartum care can be billed as a separate service only when provided by a physician or group practice that did not perform the delivery services.
- Codes: Use 59430 (use when this service has not been provided as part of the global or delivery package)
- From/To dates (Box 24A HCFA): Exact postpartum service date
- Quantity (Box 24A HCFA 1500): One
- List postpartum date in box 19 HCFA 1500 for paper claim or EDI - EDI-X-12 format list postpartum date in NTE segment
- Fill in the EXACT LMP date in box 14 of the HCFA 1500.
Multiple births
To report multiple birth deliveries:
- "Baby A" is billed with a global code for vaginal delivery on first claim line and only the vaginal delivery code is billed for "Baby B" on a second claim line.
- When twins are delivered by vaginal method, bill the code with the highest RVU as the global procedure and the second delivery with the principle procedure modifier.
- If more than a twin delivery occurs, such as triplets or quadruplets, report the total number of fetuses delivered after the first fetus in the "Units" box.
Multiple births by Cesarean section
- When twins are delivered by Cesarean section, only one code should be billed.