Obstetrical global package billing and reimbursement
Defines coding, documentation and reimbursement rules for routine obstetrical care, multiple deliveries, nutritional counseling within global period, and confirmation of pregnancy visits for Neighborhood Health Plan of Rhode Island providers.
No material clinical or coverage changes in this revision.
Obstetrical Global Package — Coverage Criteria
Coverage criteria for obstetrical services
Services included in the global obstetrical package are not separately reimbursed unless specific criteria are met; certain services may be reimbursed separately when billed with appropriate diagnosis codes and modifiers.
Separate reimbursement allowed when
- Nutritional counseling rendered within the global period is reimbursable the same day as an Evaluation and Management service by the same provider when billed with a pregnancy-related diagnosis.
- Appropriate modifiers are used to indicate a separately identifiable service and documentation/notes are provided as required to support separate reimbursement.
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