CurrentAmbetter NevadaPolicy HIM.LA.CP.MP.136

Home Births

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This policy governs when planned home birth services may be considered medically necessary and covered for members/enrollees, subject to applicable law, benefit language, participating and credentialed providers, emergency-transfer capabilities, and documented low-risk pregnancy criteria.

Policy Summary

PayerAmbetter Nevada

PolicyHome Births

Policy CodePolicy HIM.LA.CP.MP.136

Change TypeAnnual review

Effective DateN/A

Last ReviewJun 1, 2026

Next Review DateN/A

Key ActionDocument a written emergency plan showing transport to the nearest appropriate hospital within 15 minutes.

SourceLink

POLICY UPDATE CHANGES

The June 2026 annual review removed prior criteria I.C. through I.I. and replaced them with new criteria I.C.1 through I.C.8 addressing low-risk pregnancy requirements.

15 minutesEmergency transportation

2Providers required at birth

37–40 6/7 weeksGestational-age range

1–2 per 1,000Perinatal death risk

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CurrentAmbetter NevadaPolicy HIM.LA.CP.MP.136

Home Births

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Policy Summary

PayerAmbetter Nevada

PolicyHome Births

Policy CodePolicy HIM.LA.CP.MP.136

Change TypeAnnual review

Effective DateN/A

Last ReviewJun 1, 2026

Next Review DateN/A

Key ActionDocument a written emergency plan showing transport to the nearest appropriate hospital within 15 minutes.

SourceLink

POLICY UPDATE CHANGES

The June 2026 annual review removed prior criteria I.C. through I.I. and replaced them with new criteria I.C.1 through I.C.8 addressing low-risk pregnancy requirements.

15 minutesEmergency transportation

2Providers required at birth

37–40 6/7 weeksGestational-age range

1–2 per 1,000Perinatal death risk

Neonatal neurologic risk

Planned Home Birth Coverage Criteria

Provider and emergency-care requirements

Home births are considered medically necessary when coverage is mandated by law or the member/enrollee's benefit language and all of the following criteria are met.

Eligible provider and emergency infrastructure

Qualifying midwife pathway: If home birth services are managed by a midwife, the midwife is either a Certified Nurse Midwife certified by the American Midwifery Certification Board or its predecessor organizations and licensed as required; a Certified Professional Midwife licensed under the applicable midwife-practice requirements; or a certified midwife whose education and licensure meet the International Confederation of Midwives Global Standards for Midwifery Education and who practices within an integrated and regulated health system.
Applicable when home birth services are managed by a midwife.
Physician-managed pathway: If home birth services are managed by a physician, the physician practices obstetrics within an integrated and regulated health system; when the physician is not an obstetrician or a family practice physician who has completed an obstetrics fellowship, documented back-up supervision and coverage by a board-certified or active candidate for certification by the American Board of Obstetrics and Gynecology are required; emergency care is planned at a facility where the supervising obstetrician has admitting privileges; and the written emergency-care plan documents that emergency transportation to the nearest appropriate hospital can be accomplished within 15 minutes from onset of an emergency condition.
Applicable when home birth services are managed by a physician.

Required birth-attendance team

All of the following birth-attendance requirements must be met.

Two-provider attendance

Infant provider readiness: The infant-responsible provider is certified in the Neonatal Resuscitation Program and has equipment to perform a full resuscitation of the infant in accordance with the principles of the Neonatal Resuscitation Program.Neonatal Resuscitation Program certification and full resuscitation equipment

Low-risk pregnancy criteria

The member/enrollee must have a documented low-risk pregnancy with all of the following characteristics.

Low-risk pregnancy

Ultrasound and fetal status: The pregnancy is singleton with appropriate dating confirmed by ultrasound; the anatomy ultrasound shows no evidence of abnormalities; and fetal presentation is cephalic, also known as vertex.
Labor timing: The home birth plan is for spontaneous labor in a pregnancy that has lasted at least 37 0/7 but no more than 40 6/7 weeks.37 0/7–40 6/7 weeks
Maternal and pregnancy history: There is no prior history of cesarean delivery; no prior uterine surgery, such as myomectomy entering the myometrium; no preexisting medical condition that increases pregnancy risk; and no complications during pregnancy.

Fetal malpresentation, multiple gestation, and prior cesarean delivery are absolute contraindications to planned home birth. These conditions are inconsistent with the policy’s low-risk pregnancy requirements and preclude coverage under the planned home birth criteria.

A pregnancy is excluded from the documented low-risk criteria when there is prior uterine surgery, including myomectomy entering the myometrium; a preexisting medical condition that increases pregnancy risk; or any pregnancy complication. The pregnancy must also meet the remaining low-risk requirements, including appropriate ultrasound-confirmed dating, a normal anatomy ultrasound, cephalic presentation, and planned spontaneous labor from 37 0/7 through 40 6/7 weeks.

Coding and Operational Parameters

CPT CodesCPT

59400	Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and /or forceps) and postpartum care.
59409	Vaginal delivery only (with or without episiotomy and/or forceps).
59410	Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care.
59414	Delivery of placenta (separate procedure).

Emergency transportation

RequirementEmergency transportation to the nearest appropriate hospital must be accomplished within 15 minutes from the onset of an emergency condition.

Gestational age

Planned laborSpontaneous labor is planned in a pregnancy that has lasted at least 37 0/7 but no more than 40 6/7 weeks.

Provider Documentation and Denial Risks

Documentation Required

Provider Qualifications and Credentialing

Home birth services must be overseen by a participating and credentialed Plan provider. When managed by a midwife, the midwife must meet an approved qualification; physician-managed births must satisfy the applicable obstetric practice, supervision, and coverage requirements.

Certified Nurse Midwife (CNM) certified by the American Midwifery Certification Board or predecessor organization and licensed by the applicable state nursing board.
Certified Professional Midwife (CPM) licensed under the applicable midwife practitioners law.
Certified midwife whose education and licensure meet the International Confederation of Midwives (ICM) Global Standards for Midwifery Education and who practices within an integrated and regulated health system.
A physician must practice obstetrics within an integrated and regulated health system. If not an obstetrician or family-practice physician who completed an obstetrics fellowship, document back-up supervision and coverage by a board-certified or active American Board of Obstetrics and Gynecology certification candidate.

Documentation Required

Emergency Care and Transport Plan

Background

Planned home birth is an elective alternative to delivery in a hospital or birthing center. The policy recognizes that some individuals may choose this setting and notes that it may involve fewer maternal interventions, but evidence has associated planned home birth with increased neonatal or perinatal mortality risk compared with planned hospital birth. Safe planning therefore depends on careful candidate selection, collaboration and referral when needed, timely transfer to hospital care, and immediate neonatal resuscitation capability.

Definitions

Planned home birth

DefinitionAn elective alternative to delivery in a birthing center or hospital setting.

Cephalic presentation

DefinitionA fetal presentation in which the fetus is positioned head first for delivery; also known as vertex presentation.

Policy Summary

PayerAmbetter Nevada

PolicyHome Births

Policy CodePolicy HIM.LA.CP.MP.136

Change TypeAnnual review

Effective DateN/A

Last ReviewJun 1, 2026

Next Review DateN/A

Key ActionDocument a written emergency plan showing transport to the nearest appropriate hospital within 15 minutes.

SourceLink

On This Page

Maintain a written emergency care plan. The plan must document that emergency transportation to the nearest appropriate hospital can be accomplished within 15 minutes from onset of an emergency condition.

For physician-managed births, emergency care must be planned at a facility where the supervising obstetrician has admitting privileges.
Document the emergency transport capability and the designated receiving hospital in the written plan.

Documentation Required

Two-Provider Neonatal Readiness

Plan for two care providers to be present at every birth, with distinct responsibilities for the birthing individual and the infant. The infant-focused provider must be prepared to provide immediate, full neonatal resuscitation.

One provider has primary responsibility for the birthing individual.
A second provider has primary responsibility for the infant and is certified in the Neonatal Resuscitation Program (NRP).
The infant-focused provider has the equipment and training, skills, and readiness to perform a full resuscitation of the infant in accordance with NRP principles.
Optimize provisions for potential resuscitation of a depressed newborn and immediate neonatal care in the home setting.

Documentation Required

Low-Risk Pregnancy Documentation

Document that the member/enrollee has a low-risk pregnancy meeting every listed criterion before planned home birth.

Singleton pregnancy with appropriate dating confirmed by ultrasound.
Anatomy ultrasound completed with no evidence of abnormalities.
Cephalic (vertex) fetal presentation.
Plan is for spontaneous labor at 37 0/7 through 40 6/7 weeks of pregnancy.
No prior cesarean delivery or prior uterine surgery, such as myomectomy entering the myometrium.
No preexisting medical condition that increases pregnancy risk and no pregnancy complications.

Denial Risk

Provider, Emergency-Plan, or Transport Requirements Not Met

Home birth is at denial risk when provider participation or credentialing, required qualifications, emergency planning, or transport capability is not documented or does not meet policy requirements.

Deny when the overseeing provider is not participating and credentialed or does not meet the applicable midwife or physician qualifications.
Deny when required physician back-up supervision, coverage, or obstetric admitting-privilege arrangements are absent.
Deny when the written emergency care plan is absent or does not document transport to the nearest appropriate hospital within 15 minutes from emergency onset.

Denial Risk

Required Two-Provider Team Not Present

Home birth is at denial risk when the required plan for two care providers to attend the birth is absent or does not assign the required neonatal-readiness role.

Require one provider with primary responsibility for the birthing individual and a second provider with primary responsibility for the infant.
The infant-focused provider must be NRP-certified and have equipment and capability to perform full neonatal resuscitation in accordance with NRP principles.

Denial Risk

Low-Risk Pregnancy Criteria Not Met

Home birth is at denial risk when any low-risk pregnancy criterion is not met. Fetal malpresentation, multiple gestation, and prior cesarean delivery are identified as absolute contraindications to planned home birth.

Deny when the pregnancy is not singleton, dating is not appropriately confirmed by ultrasound, or the anatomy ultrasound shows abnormalities.
Deny for non-cephalic (malpresentation) presentation, labor outside 37 0/7 through 40 6/7 weeks, or a plan other than spontaneous labor.
Deny when there is a prior cesarean delivery, prior uterine surgery, a preexisting condition that increases pregnancy risk, or any pregnancy complication.