CurrentLouisiana Department of HealthPolicy 16-21

Global Maternity Procedure Codes

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This policy governs when Healthy Louisiana plans and fee-for-service Medicaid will recognize and consider global maternity procedure codes for payment. It establishes billing, rebilling, payer-position, and timely filing requirements.

Policy Summary

PayerLouisiana Department of Health

PolicyGlobal Maternity Procedure Codes

Policy CodePolicy 16-21

Change TypeAdded payment consideration for qualifying claims

Effective DateNovember 7, 2016

Next Review DateN/A

Key ActionBill global maternity procedure codes only when the health plan and fee-for-service Medicaid are billed as secondary payer.

SourceLink

POLICY UPDATE CHANGES

Healthy Louisiana plans and fee-for-service Medicaid began accepting global maternity procedure codes for qualifying claims.

8Global maternity procedure codes listed

Secondary onlyPayer position required for consideration of payment

DeniedClaims billed with Medicaid as primary payer

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CurrentLouisiana Department of HealthPolicy 16-21

Global Maternity Procedure Codes

Customize your policy alerts

Sign up for Louisiana Department of Health Policy 16-21 alerts

Get alerted when Policy 16-21 changes without checking for updates manually.

Monitor payer policy activity

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Policy Summary

PayerLouisiana Department of Health

PolicyGlobal Maternity Procedure Codes

Policy CodePolicy 16-21

Change TypeAdded payment consideration for qualifying claims

Effective DateNovember 7, 2016

Next Review DateN/A

Key ActionBill global maternity procedure codes only when the health plan and fee-for-service Medicaid are billed as secondary payer.

SourceLink

POLICY UPDATE CHANGES

Healthy Louisiana plans and fee-for-service Medicaid began accepting global maternity procedure codes for qualifying claims.

8Global maternity procedure codes listed

Secondary onlyPayer position required for consideration of payment

DeniedClaims billed with Medicaid as primary payer

Conditions for Payment Consideration

Conditions for payment consideration

A global maternity procedure code may be considered for payment when all applicable billing conditions are met.

ALL of the following

The claim must meet all of the following
- The claim uses one of the listed global maternity procedure codes.
- The health plan and fee-for-service Medicaid are billed as secondary payer.
- The claim is not a rebill of services previously billed individually.
- The claim meets the applicable submission deadline and timely filing requirement, including submission by February 7, 2017 for dates of service from June 1, 2015 through February 6, 2016, or within the one-year timely filing period for dates of service on or after February 7, 2016.

Primary payer exclusion

Claims are not payable under this policy when the health plan and fee-for-service Medicaid are billed as primary payer.

The health plan and fee-for-service Medicaid are billed as primary payer.

Claims billed with Medicaid as primary payer will be denied.

Global Maternity Coding and Filing Requirements

Covered CPT CodesCPTCovered

59400	Obstetrical care
59410	Vaginal delivery only, including postpartum care
59510	Routine obstetric care; antepartum, delivery, and postpartum care
59515	Cesarean delivery with postpartum care
59610	VBAC delivery, including antepartum and postpartum care
59614	VBAC delivery including postpartum care
59618	Attended VBAC delivery including antepartum and postpartum care
59622	Attempted VBAC including postpartum care

Historical Claim Submission Deadline

Submission deadlineFebruary 7, 2017

Applicable dates of serviceJune 1, 2015 through February 6, 2016

Timely Filing Period

Timely filing periodOne year

Applicable dates of serviceOn or after February 7, 2016

Filing requirementClaims are subject to one-year timely filing edits

Billing Actions and Denial Risks

Billing Rule

Secondary Payer Billing Required

Bill global maternity procedure codes only when both the health plan and fee-for-service Medicaid are billed as secondary payer. Claims billed to the health plan and fee-for-service Medicaid as primary payer will be denied.

Denial Risk

Do Not Rebill Individual Services

Do not rebill claims that were already billed as individual services using global maternity procedure codes.

Billing Rule

Optional Use of Global Maternity Codes