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    v1.0.28
    OpenPayerBilling CodesAlcohol and Drug Abuse TreatmentHCPCS hcpcs-h1000-prenatal-risk-assessment
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    HCPCS H1000: Prenatal Care, At-Risk Assessment

    HCPCS Level II code H1000 represents a prenatal at-risk assessment service performed to evaluate pregnancy risk factors, prenatal health status, and need for additional monitoring or interventions; the service is typically delivered as a prenatal care assessment in outpatient obstetrics clinics, prenatal care centers, or community health settings and documents clinical findings and recommended follow-up.

    For related coverage guidance, see recent payer policy updates: Home Health, Skilled, and Custodial Care Services (for Idaho Only), Private Duty Nursing Services, Private Duty Nursing Services (for Florida Only).

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    Table of contents

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    • Billing CodesCPT, HCPCS, DRG & more
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    • ModifiersCPT modifiers & usage
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    Clinical & Coding Specifications

    Clinical Context

    A pregnant patient in the first trimester presents to a prenatal clinic for an initial prenatal visit and at-risk assessment coded by H1000. The patient may have medical, obstetric, social, or behavioral risk factors (for example: prior preterm birth, chronic hypertension, diabetes, substance use, advanced maternal age, or inadequate prenatal care access). Clinical workflow begins with triage and registration, review of prenatal records and prior pregnancies, focused history (medical, obstetric, medication, social determinants), vital signs, and targeted physical exam. The clinician performs an at-risk screening that includes assessment of maternal comorbidities, psychosocial screening, identification of barriers to care, and development of a risk-based prenatal plan. Laboratory and screening orders (blood type, CBC, infectious disease testing) and referrals (maternal-fetal medicine, behavioral health, social work) are placed as indicated. Documentation includes reason for visit, risk assessment findings, counseling provided, care plan, and any referrals or follow-up. Typical sites of service are outpatient prenatal clinics, community health centers, federally qualified health centers, and obstetrics/gynecology ambulatory offices. Typical encounter duration varies from 20 to 60 minutes depending on complexity of the risk assessment and counseling.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    59425Antepartum care only; 4-6 visitsUsed when ongoing antepartum management follows initial at-risk assessment and billing is for antenatal care only
    99203Office or other outpatient visit for the evaluation and management of a new patient, typically 30 minutesMay be used when a new prenatal patient presents and a comprehensive at-risk assessment is performed as an E/M visit
    99214Office or other outpatient visit for an established patient, typically 25 minutesMay be used for established prenatal patients when a detailed at-risk assessment and management occur
    76801Ultrasound, pregnancy, real time for pregnancy (less than 14 weeks)Ordered commonly after risk assessment if early ultrasound is indicated for dating or viability
    81025Urine pregnancy test by dipstickCommon point-of-care test ordered or performed during initial prenatal/at-risk assessment
    80055Obstetric panel (first trimester - includes CBC, blood type, antibody screen, RPR, HIV, hepatitis B)Frequently ordered as baseline testing when risk assessment identifies prenatal needs

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    33Modifier 33 was created by the American Medical Association in response to the Affordable Care Act to identify services provided for preventive intent. It is appended to CPT/HCPCS codes that could be…- Use modifier -33 when a CPT/HCPCS service that can be billed as either preventive or diagnostic/treatment is provided with preventive intent and aligns with USPSTF A or B recommendations or other…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    367A00000XAdvanced Practice MidwifeAdvanced practice midwifery encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproduc…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    364SP0809XAdult Psychiatric/Mental Health Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    3336M0002XMail Order PharmacyA pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers t…
    133VN1401XPediatric Critical Care Nutrition Registered DietitianAn individual who is a Board Certified Specialist in Pediatric Critical Care Nutrition and applies evidence-based nutrition knowledge in providing med…

    Related ICD-10-CM Codes

    13 rows

    ICD-10-CM CodeDescription
    O09.211Supervision of pregnancy with history of pre-term labor, first trimester
    O09.212Supervision of pregnancy with history of pre-term labor, second trimester
    O09.213Supervision of pregnancy with history of pre-term labor, third trimester
    O09.511Supervision of elderly primigravida, first trimester
    O09.512Supervision of elderly primigravida, second trimester
    O09.513Supervision of elderly primigravida, third trimester
    O09.519Supervision of elderly primigravida, unspecified trimester
    O10.013Pre-existing essential hypertension complicating pregnancy, third trimester
    O24.419Gestational diabetes mellitus in pregnancy, unspecified control
    O26.21Pregnancy care for patient with recurrent pregnancy loss, first trimester

    Showing 1–10 of 13

    Related Payer Policy Updates

    Specialty: Home Health & Hospice1 / 3

    10 rows

    PolicyPayerEffective Date
    Home Health, Skilled, and Custodial Care Services (for Idaho Only)UnitedHealthcare2026-08-01
    Private Duty Nursing ServicesColorado Rocky Mountain Health Plans2026-08-01
    Private Duty Nursing Services (for Florida Only)Colorado Rocky Mountain Health Plans2026-08-01
    Private Duty Nursing Services (for New Jersey Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for Kentucky Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for New Mexico Only)UnitedHealthcare2026-08-01
    Private Duty Nursing Services (for Kansas Only)UnitedHealthcare2026-08-01
    Private Duty Nursing ServicesColorado Rocky Mountain Health Plans2026-08-01
    Home Health, Skilled, and Custodial Care Services (for Ohio Only)UnitedHealthcare2026-08-01
    Home Health, Skilled, and Custodial Care ServicesColorado Rocky Mountain Health Plans2026-07-01

    Related Codes

    HCPCS-H0001-ALCOHOL-DRUG-ASSESSMENT-OUTPATIENT

    HCPCS H0001: Alcohol and/or Drug Assessment

    HCPCS-H0002-BEHAVIORAL-HEALTH-SCREENING-ADMISSION-ELIGIBILITY

    HCPCS H0002: Behavioral Health Screening for Treatment Admission

    HCPCS-H0003-ALCOHOL-DRUG-SCREENING-LAB-ANALYSIS

    HCPCS Level II H0003: Alcohol and/or Drug Screening Laboratory Analysis

    HCPCS-H0004-BEHAVIORAL-HEALTH-COUNSELING-15-MINUTE

    HCPCS H0004: Behavioral Health Counseling and Therapy, per 15 Minutes

    HCPCS-H0005-GROUP-COUNSELING-SUBSTANCE-USE-CLINICIAN

    HCPCS H0005: Alcohol and/or Drug Group Counseling by Clinician

    HCPCS-H0006-ALCOHOL-DRUG-CASE-MANAGEMENT

    HCPCS H0006: Alcohol and/or Drug Services, Case Management

    HCPCS-H0007-ALCOHOL-DRUG-CRISIS-INTERVENTION-OUTPATIENT

    HCPCS H0007: Alcohol and/or Drug Crisis Intervention (Outpatient)

    HCPCS-H0008-SUB-ACUTE-DETOXIFICATION-HOSPITAL-INPATIENT

    HCPCS H0008: Alcohol and/or Drug Sub-Acute Detoxification (Inpatient)

    HCPCS-H0009-ACUTE-DETOXIFICATION-HOSPITAL-INPATIENT

    HCPCS Level II H0009: Acute Detoxification, Hospital Inpatient

    HCPCS-H0010-SUB-ACUTE-RESIDENTIAL-DETOXIFICATION

    HCPCS H0010: Sub-Acute Detoxification, Residential Inpatient

    Showing 1–10 of 93

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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