RetiredPremera BluecrossPolicy N/A

Modifier TH (Obstetrical treatment/services) use on E&M and home/residence visit claims

Defines when Premera recognizes Modifier TH appended to professional E&M (99202-99215) or home/residence visit (99341-99350) codes to indicate antepartum visits 1-3 and related billing restrictions; applies to Premera Blue Cross and affiliated lines of business (except Alaska).

Policy Summary

PayerPremera Bluecross

PolicyModifier TH (Obstetrical treatment/services) use on E&M and home/residence visit claims

Policy CodePolicy N/A

Change TypeAdded codesarchival

Effective DateN/A

Next Review DateN/A

Key ActionAppend Modifier TH to E&M office or home/residence visit codes only for antepartum visits 1–3; for more than three antepartum visits submit 59425/59426 or an appropriate global maternity code.

SourceLink

POLICY UPDATE CHANGES

Added global maternity care codes (59400, 59510, 59610, 59618) to Codes/Coding Guideline section and allowed billing of a global maternity care procedure code when complete maternity care is rendered.

Policy statement was clarified to indicate visits four and greater require appropriate prenatal visit codes rather than office visit codes.

Policy was archived effective April 2, 2026.

1–3Modifier TH applicable to these visits

>3>3 visits require antepartum/global code

Alaska excludedState-level exception

04/02/26

Policy Summary

PayerPremera Bluecross

PolicyModifier TH (Obstetrical treatment/services) use on E&M and home/residence visit claims

Policy CodePolicy N/A

Change TypeAdded codesarchival

Effective DateN/A

Next Review DateN/A

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.

Modifier TH Coverage Criteria

Modifier TH coverage criteria

Covered when ALL of the following are met:

Modifier TH is recognized when appended to an E&M office visit (99202-99215) or a home/residence visit (99341-99350) to indicate antepartum visits 1-3.

Modifier TH is not appended to any postpartum E&M visit code.

An E&M office visit or home/residence visit code appended with Modifier TH should not be billed by the same provider or provider group that bills a global maternity care code (59400, 59510, 59610, 59618).

If more than three antepartum visits are provided by the same provider, submit antepartum visit codes (59425 or 59426) or an appropriate global maternity care code (59400, 59510, 59610, 59618) when complete maternity care is rendered.

Alaska providers are not subject to this Modifier TH policy (state-level exception).

Policy status: This policy is archived effective April 2, 2026; refer to the Maternity Services policy for related information.

Applicable CPT and Obstetrical Codes

Applicable CPT/obstetrical codesCPT

99202-99205, 99211-99215	New and established patient office/outpatient E&M visit codes (see policy for time and complexity descriptors).
99341-99345, 99347-99350	New and established patient home or residence visit codes (see policy for time thresholds).
59425, 59426, 59430	Antepartum and postpartum visit codes.
59400, 59510, 59610, 59618	Global obstetrical care codes including antepartum and postpartum care and delivery.

Time/complexity thresholds for E&M and home/residence codes

99202 (new patient office) - time threshold15 minutes when using time for code selection

99203 - time threshold30 minutes when using time for code selection

99204 - time threshold45 minutes when using time for code selection

99205 - time threshold60 minutes when using time for code selection

Established patient office visit thresholds (99211-99215)99211: may not require physician; 99212: 10 min; 99213: 20 min; 99214: 30 min; 99215: 40 min

Home/residence visit time thresholds (selected)New patient: 99341: 15 min; 99342: 30 min; 99344: 60 min; 99345: 75 min. Established patient: 99347: 20 min; 99348: 30 min; 99349: 40 min; 99350: 60 min

Billing and Provider Actions

Billing Rule

Modifier TH — billing and submission rules

Append Modifier TH to an E&M office visit (99202-99215) or a home/residence visit (99341-99350) only to indicate antepartum visits 1-3. Do not append TH to any postpartum E&M visit code. Do not bill an E&M or home/residence visit appended with TH if the same provider or provider group bills a global maternity care code. For more than three antepartum visits by the same provider, submit antepartum visit codes (59425 or 59426) or an appropriate global maternity care code (59400, 59510, 59610, 59618) when complete maternity care is rendered.

Apply TH only to antepartum visits 1-3 on 99202-99215 or 99341-99350.
Do not append TH to postpartum E&M visit codes.
Do not bill TH-appended visits if the same provider/provider group bills a global maternity code.
For >3 antepartum visits, use 59425 or 59426 or an appropriate global maternity code when complete maternity care is provided.

Key Definitions

Modifier TH

Definition - Modifier THModifier TH = Obstetrical treatment/services modifier appended to an E&M or home/residence visit code to indicate antepartum visits 1-3

Billing scopeAppend TH only to E&M office visit codes (99202-99215) or home/residence visit codes (99341-99350) to indicate antepartum visits 1-3

Exclusion - postpartumModifier TH is not appended to any postpartum E&M visit code

Antepartum/Postpartum codes

59425Antepartum care only; 4-6 visits

59426Antepartum care only; 7 or more visits

59430