CurrentAlaska MedicaidPolicy N/A

Direct Entry Midwife Services - Reimbursement

Defines Alaska Medicaid reimbursement rates and billing details for services provided by direct entry midwives, including CPT/HCPCS codes, NDC/pricing notes, and authorization flags affecting providers billing Medicaid in Alaska.

Policy Summary

PayerAlaska Medicaid

PolicyDirect Entry Midwife Services - Reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2025

Next Review DateN/A

Key ActionSubmit claims using the listed CPT/HCPCS codes and include NDC-priced amounts where shown; follow authorization flags indicated per code.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~60procedure and supply codes listed

$3,432.66highest listed NDC-priced procedure (59400)

$190.50newborn metabolic screen (S3620)

7/1/2025policy effective period start

Coverage and Payment Criteria

Payment and authorization criteria by code

Policy Summary

PayerAlaska Medicaid

PolicyDirect Entry Midwife Services - Reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2025

Next Review DateN/A

Key ActionSubmit claims using the listed CPT/HCPCS codes and include NDC-priced amounts where shown; follow authorization flags indicated per code.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Code 59400 — Obstetrical care: NDC-priced at $3,432.66; no Comagine or Fiscal Agent authorization required; no medical justification required.

Code 59409 — Obstetrical care: NDC-priced at $1,155.72; no Comagine or Fiscal Agent authorization required; no medical justification required.

Code 59410 — Obstetrical care: NDC-priced at $1,555.94; no Comagine or Fiscal Agent authorization required; no medical justification required.

Code 59414 — Deliver placenta: NDC-priced at $129.97; no Comagine or Fiscal Agent authorization required; no medical justification required.

Code 59430 — Care after delivery: NDC-priced at $363.96; no Comagine or Fiscal Agent authorization required; no medical justification required.

Code 59899 — Unlisted perinatal/maternal care & delivery: NDC = By Report; no Comagine or Fiscal Agent authorization required; no medical justification required.

Code 99050 — Medical services after hours: NDC-priced at $24.90; Requires Medical Justification = X.

Code 99202 — Office/outpatient new (15 min): NDC-priced at $103.42; no Comagine or Fiscal Agent authorization required; no medical justification required.

Code S3620 — Newborn metabolic screening: NDC-priced at $190.50; no Comagine or Fiscal Agent authorization required; no medical justification required.

Selected injectable drugs and supplies (examples): J2210, J2590, J2700, J2790, J3420, J3430, J7040, J7042, J7050, J7060, J7120 — Priced by NDC; many require Fiscal Agent Authorization = X (see individual code entries).

Authorization Flags and Provider Billing Notes

Prior Authorization

Code-level authorization and pricing flags

Code-level flags indicate whether a specific procedure or drug requires medical justification, Comagine (utilization management) authorization, fiscal agent authorization, and whether pricing is determined by NDC or a fixed NDC price. Review each billed code for the presence of these flags before submitting claims to avoid denials or incorrect pricing.

Many obstetrical and midwifery CPT/HCPCS/J-code items in this section include one or more of the following per-code flags: Requires Medical Justification (clinical documentation may be required), Requires Comagine Authorization (prior authorization via the managed care/UM vendor), Requires Fiscal Agent Authorization (authorization recorded by the fiscal agent), and Requires NDC / Priced by NDC (drug/supply reimbursed based on NDC pricing or a specific NDC dollar amount).
Examples from this section: 59400, 59409, 59410, 59414, 59430, 59899 and multiple E/M and home visit codes show explicit NDC amounts or 'By Report' NDC; injectable drugs and infusions (J-codes and J7xxx series) are marked 'Priced by NDC' and several J-codes (J2210, J2590, J2700, J2790, J3420, J3430) show fiscal agent authorization = X.
Action: Verify each claim line includes correct code-level authorization and pricing flags, attach required clinical documentation if 'Requires Medical Justification' is present, and obtain the necessary authorization from Comagine or the fiscal agent when indicated prior to rendering services.

Documentation Required

Authorization notes for drugs, supplies, and select services

Certain drugs, supplies, and select services require special authorization steps or have specific billing/pricing notes. Confirm these requirements before ordering or billing.

Drugs priced by NDC: Multiple J-codes (for example J2210 Methylergonovine, J2590 Oxytocin, J2700 Oxacillin, J2790 Rho(D) immune globulin, J3420 Vitamin B12, J3430 Vitamin K) are flagged 'Priced by NDC' — submit NDC and unit information on the claim.
Fiscal agent authorization required: Several injectable drugs and infusion supplies (notably J2210, J2590, J2700, J2790, J3420, J3430, and many J70xx intravenous solutions) show 'Requires Fiscal Agent Authorization = X' — obtain fiscal agent authorization per program instructions before billing.
Specific NDC amounts provided: Some procedure codes and services include fixed NDC-dollar values (examples: 59400 $3,432.66; 59409 $1,155.72; 59410 $1,555.94; 59414 $129.97; 59430 $363.96; selected E/M and visit codes list NDC dollar values such as 99202 $103.42, 99203 $162.79, 99212 $80.97, etc.) — billers should use the listed NDC/pricing where applicable.
'By Report' NDC: Unlisted maternity procedure 59899 is flagged 'Requires NDC = By Report' — when billing, report the NDC and supporting documentation to justify pricing.
After-hours service: 99050 (Medical services after hours) is marked 'Requires Medical Justification = X' — ensure documentation supports medical necessity for after-hours billing.
Newborn screening and pap smear: Q0091 (Pap smear collection) and S3620 (Newborn metabolic screening) have specified NDC-dollar values in this listing — verify applicable laboratory/screening billing follows these price indicators.
Action: For each listed drug, supply, or service, include required NDC details on the claim, secure fiscal agent or Comagine authorization when flagged, and retain clinical documentation for 'Requires Medical Justification' items to support payment and prevent denials.

59400	OBSTETRICAL CARE
59409	OBSTETRICAL CARE
59410	OBSTETRICAL CARE
59414	DELIVER PLACENTA
59430	CARE AFTER DELIVERY
59899	UNLISTED PX MAT CARE&DLVR
99050	MEDICAL SERVICES AFTER HRS
99202	OFFICE O/P NEW SF 15 MIN
99203	OFFICE O/P NEW LOW 30 MIN
99204	OFFICE O/P NEW MOD 45 MIN

OpenPayer

Direct Entry Midwife Services - Reimbursement

Coverage and Payment Criteria

Codes, Descriptions, and Policy Period

Authorization Flags and Provider Billing Notes

RBRVS Rounding and Lab Fee Schedule References