Effective May 1, 2019, Missouri Care will transition from allowing global billing to allowing only “per visit” billing for each obstetrical service. The “per visit” information will improve our ability to track and evaluate prenatal and postpartum care for our members.
Prenatal visits should be billed with the appropriate E&M code with modifier-TH. Postpartum visits within 21 to 56 days of delivery should be submitted using code 59430 with modifier-TH. Postpartum visits outside of the 21 to 56 day time period should be submitted using the appropriate E&M code or 59430 without the modifier.
Examples of codes that should be used to bill obstetrical services under the new guidelines are shown below:
Prenatal Care
99213-TH Use appropriate E&M code with –TH modifier (99213 is illustrative only)
Delivery
59409 Vaginal Delivery Only
59514 C-Section Delivery Only
59612 VBAC – Vaginal Delivery after Previous Cesarean
59620 C-Section Delivery Only after attempted VBAC
59622 C-Section following attempted Vaginal Delivery after prior C-Section
Global codes will be denied.
Postpartum Care
59430-TH Postpartum Care performed 21 to 56 days from delivery
99213 or Use appropriate E&M code (99213 is illustrative only) or 59430 without
59430 the TH modifier for postpartum care performed less than 21 or more than
56 days from delivery
If you have a Missouri Care patient that is currently receiving prenatal care and you intended to bill using a global or bundled code, please submit claims for any prenatal visits already provided with the appropriate coding outlined above. Any global or bundled codes with a date of service on or after May 1, 2019 will be denied.
