CurrentEmpire BluecrossPolicy N/A

Multiple Delivery Services Professional (Commercial Reimbursement Policy)

Defines professional reimbursement rules for multiple births (vaginal and cesarean) for commercial members and applies to providers billing Anthem/Empire BlueCross unless overridden by contractual or legal mandates.

Policy Summary

PayerEmpire Bluecross

PolicyMultiple Delivery Services Professional (Commercial Reimbursement Policy)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateApr 29, 2022

Next Review DateN/A

Key ActionFollow authorization and medical necessity guidelines appropriate to the procedure and diagnosis; state and federal law and contract language take precedence.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

50%reimbursement rate for each subsequent vaginal delivery

Modifier 59modifier for vaginal deliveries

Modifier 22modifier for cesarean deliveries

07/17/2024last approval/review date

Multiple Delivery Reimbursement Criteria

Multiple delivery reimbursement criteria

Anthem allows reimbursement for multiple births using same‑delivery or combined‑delivery methods with the following billing and reimbursement rules, subject to authorization, medical necessity, and contractual or legal mandates.

Vaginal deliveries involved in multiple births should be billed with Modifier 59.

Each subsequent vaginal delivery is eligible for reimbursement at 50% of the allowance.

Cesarean deliveries involved in multiple births should be billed with Modifier 22.

Documentation for cesarean deliveries will be reviewed to determine if additional reimbursement is warranted for services eligible for reimbursement.

State and federal law, and contract language (including member contract benefits in effect on date of service) take precedence over this policy.

Policy Summary

PayerEmpire Bluecross

PolicyMultiple Delivery Services Professional (Commercial Reimbursement Policy)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateApr 29, 2022

Next Review DateN/A

Key ActionFollow authorization and medical necessity guidelines appropriate to the procedure and diagnosis; state and federal law and contract language take precedence.

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.

Modifiers, Payment Reductions, and Code Guidance

Modifiers for multiple deliveriesModifierCovered

Modifier 59	Used to bill vaginal deliveries in multiple births
Modifier 22	Used to bill cesarean deliveries in multiple births when additional reimbursement may be warranted

inv-03: Payment reduction for subsequent vaginal deliveries

Payment ruleEach subsequent vaginal delivery in a multiple birth is reimbursed at 50% of the allowance.

Applies toVaginal deliveries involved in multiple births billed using same-delivery or combined-delivery methods.

Related billing modifierUse Modifier 59 for vaginal deliveries in multiple births.

DocumentationClaims must be supported by medical records per general reimbursement requirements.

Reimbursement and Billing Requirements

inv-05: General reimbursement and billing requirements

Documentation requirementServices billed must be fully supported by the medical record and/or office notes.

Accepted coding systemsUse Current Procedure Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and revenue codes where appropriate.

Billing modifiers for multiple birthsModifier 59 for vaginal deliveries; Modifier 22 for cesarean deliveries.

Submission rulesFollow industry-standard, compliant codes on all claim submissions; noncompliance may result in recovery, recoupment, rejection, or denial.

Superseding rulesProvider, state, federal, or CMS mandates and contract language take precedence over this policy.

OpenPayer

Multiple Delivery Services Professional (Commercial Reimbursement Policy)

Multiple Delivery Reimbursement Criteria

Modifiers, Payment Reductions, and Code Guidance

Authorization, Documentation, and Legal Precedence

Reimbursement and Billing Requirements