Billing for Prenatal and Delivery Services

Topics included in this section:

Prenatal care billing information

Go to information on billing for prenatal care:

• Individual visits (3 or less)
• Prenatal services only (no associated delivery)
• Prenatal with delivery and postpartum (7 or more prenatal visits)
• High-risk pregnancies
• Illness during prenatal period

Prenatal education billing codes

See the chart of Prenatal education billing codes.

Delivery & postpartum care billing information

Go to information on billing for delivery & postpartum care:

• Delivery only (no prenatal or postpartum care)
• Delivery and postpartum care (no prenatal)
• Postpartum care only (no associated delivery)
• Cesarean section
  
• Multiple birth deliveries
• Multiple births by Cesarean section

When additional information may be needed

Priority Health will return claims for additional information in some cases. Examples include:

• Member became effective with Priority Health during the pregnancy: Another insurance plan or the member would be responsible for the portion of the payment for services
• Member loses coverage during pregnancy
• Member changes from a Priority Health self-funded plan to a Priority Health fully funded plan, or vice versa (payor changes from the employer to Priority Health or vice versa)