Summary & Overview
HCPCS G0064: Certified Nurse Midwife MIPS Specialty Set
HCPCS Level II code G0064 identifies the Certified Nurse Midwife MIPS specialty set, a structured collection of quality measures and reporting elements for certified nurse midwives participating in MIPS. Nationally, this designation matters because it standardizes performance reporting for midwifery care, contributes to value-based payment calculations, and supports quality measurement across ambulatory maternal and gynecologic services. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code represents, why specialized MIPS sets for certified nurse midwives are important for national quality reporting, and which major payers cover or recognize this specialty set. The publication provides an overview of benchmarking and reporting context, summarizes typical clinical settings for application, and notes where input data is not available. It also highlights implications for quality measurement and administrative workflows tied to MIPS reporting for certified nurse midwives. Data not available in the input will be explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code G0064 denotes the Certified Nurse Midwife MIPS specialty set. This code represents a set of quality measures and reporting elements aligned to the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System (MIPS) for clinicians practicing as certified nurse midwives.
Service Type: Quality measurement and MIPS reporting for certified nurse midwives
Typical Site of Service: Outpatient ambulatory settings where certified nurse midwives provide care, including prenatal, postpartum, and routine gynecologic services in clinics and physician offices.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A certified nurse-midwife (CNM) submits a MIPS specialty set for quality reporting under the Medicare Promoting Interoperability and Quality Payment Program. Typical patients are pregnant women receiving prenatal, intrapartum, or postpartum care in outpatient obstetric clinics, birthing centers, or hospital labor and delivery units. A common scenario: a 28-year-old G2P1 at 32 weeks gestation attends a routine prenatal visit at a community-based obstetric clinic run by a CNM. The visit includes a focused history, maternal vital signs, fetal heart rate assessment with Doppler, urine testing for protein and glucose, discussion of fetal movement patterns, and documentation of counseling on prenatal vaccines and breastfeeding. The CNM documents all elements required for the specialty MIPS set and submits G0064 to indicate reporting under the certified nurse midwife MIPS specialty set. Typical workflow steps: patient check-in and intake vitals, review of prenatal records, focused physical and fetal assessment by the CNM, point-of-care testing (urine), counseling and education, documentation of quality measures and eCQMs, and submission of the MIPS specialty reporting code and any applicable visit CPT codes to the payer. Typical sites of service include outpatient obstetric clinics, community health centers, birthing centers, and hospital-based prenatal clinics.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services |