CurrentPremera BluecrossPolicy N/A

Multiple Deliveries / Multiple Births billing and reimbursement

Defines how the Plan limits and reimburses professional claims for multiple gestation/multiple birth maternity cases (vaginal, cesarean, or combination) and who may bill; applies to Premera Blue Cross and affiliated products.

Policy Summary

PayerPremera Bluecross

PolicyMultiple Deliveries / Multiple Births billing and reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateDec 1, 2001

Next Review DateMar 12, 2026

Key ActionBill all multiple births on the same professional claim with each birth on a separate line and append modifier 59 to second and subsequent births to indicate separate and distinct deliveries.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Append modifier 59modifier required to indicate distinct subsequent births

Modifier 22 allowedincreased procedural services for maternity complications

Multiple code listsCPT code sets enumerated

Z37.x requiredmultiple birth outcome diagnosis codes required

CMS-1500 / 837Pclaim form / professional services scope

Policy Summary

PayerPremera Bluecross

PolicyMultiple Deliveries / Multiple Births billing and reimbursement

Policy CodePolicy N/A

Change TypeNo material change

Effective DateDec 1, 2001

Next Review DateMar 12, 2026

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.

Multiple Births Reimbursement Criteria

Multiple Births reimbursement criteria

Reimbursement rules and required claim elements for multiple births — covered when the following billing, coding, modifier, and documentation requirements are met:

All multiple births must be billed on the same professional claim with each birth on a separate line; failure to do so may result in denial of reimbursement.

A multiple birth outcome diagnosis code (Z37.x) must be present at the claim level; other related conditions and complications should also be submitted as diagnosis codes.

Append modifier 59 to second and subsequent birth delivery-only codes when necessary to distinguish separate and distinct multiple deliveries (e.g., twins, triplets).

For cesarean deliveries: bill either as one occurrence of a global maternity care code (cesarean only), a delivery and post-partum code (cesarean only), or a delivery-only code (cesarean only). No additional allowance will be made for subsequent newborns delivered via the same incision; these are considered part of the initial cesarean delivery.

Use the appropriate global, delivery, delivery-only, and antepartum/postpartum CPT codes as listed in the policy when billing for multiple births.

When substantial additional work is required because of maternity complications, modifier 22 (Increased Procedural Services) may be appended to the delivery code (global maternity code, delivery-only code, or delivery and postpartum procedure codes); a diagnosis reflecting the related maternity complication must be included on the claim and supporting medical records/operative reports must be submitted for review to determine if additional reimbursement is appropriate.

Codes and Diagnosis Requirements

Global Maternity Care CodesCPTCovered

59400	Routine obstetric care including antepartum care, vaginal delivery (with/without episiotomy and/or forceps), and postpartum care
59510	Routine obstetric care including antepartum care, cesarean delivery, and postpartum care
59610	Routine obstetric care including antepartum care, vaginal delivery (with/without episiotomy and/or forceps), and postpartum care after previous cesarean delivery
59618	Routine obstetric care including antepartum care, cesarean delivery, and postpartum care, following attempted vaginal delivery after previous cesarean delivery

Delivery and Post-Partum Care CodesCPTCovered

59410	Vaginal delivery only (with/without episiotomy and/or forceps) including postpartum care
59515	Cesarean delivery only including postpartum care
59614	Vaginal delivery only, after previous cesarean delivery (with/without episiotomy and/or forceps) including postpartum care
59622	Cesarean delivery only, following attempted vaginal delivery after pervious cesarean delivery including postpartum

Delivery Only CodesCPTCovered

59409	Vaginal delivery only (with/without episiotomy and/or forceps)
59514	Cesarean delivery only
59612	Vaginal delivery only, after previous cesarean delivery (with/without episiotomy and/or forceps)
59620	Cesarean delivery only, following attempted vaginal delivery after pervious cesarean delivery

Antepartum and Post-Partum Visit CodesCPTCovered

59425	Antepartum care only; 4-6 visits
59426	Antepartum care only; 7 or more visits
59430	Postpartum care only (separate procedure)

Multiple Birth Diagnosis Codes (examples)ICD-10

Z37.2	Twins, both liveborn
Z37.3	Twins, one liveborn and one stillborn
Z37.9	Outcome of delivery, unspecified

Diagnosis requirement

RequirementA multiple birth outcome diagnosis code (Z37.x) is required at the claim level and must be present on the professional claim to identify the type of multiple delivery.

Accepted codes (examples)Z37.2 (Twins, both liveborn); Z37.3 (Twins, one liveborn and one stillborn); Z37.9 (Outcome of delivery, unspecified).

Additional diagnosesAny other medical conditions or complications associated with the delivery should also be submitted on the claim.

Billing, Modifiers, and Documentation

Billing Rule

Claim Submission Requirements — Bill multiple births on one professional claim; append modifier 59 to subsequent births

Bill all multiple births on the same professional claim with each birth billed on a separate line; failure to do so may result in denial of reimbursement. Append modifier 59 to second and subsequent birth(s) to indicate they are separate and distinct from the first/initial birth.

Apply modifier 59 to second and subsequent vaginal delivery-only or cesarean delivery-only codes when appropriate to denote distinct procedural services.
First birth may be billed as a global maternity care code, a delivery and postpartum code, or a delivery-only code; subsequent births billed on separate lines with modifier 59.

Documentation Required

Documentation for Increased Services — Use modifier 22 with supporting medical records

Key Terms and Modifier Meaning

Multiple birth claim handling

Billing formatAll multiple births must be billed on the same professional claim with each birth billed on a separate line; failure to do so may result in denial of reimbursement.

Modifier for subsequent birthsAppend modifier 59 to second and subsequent birth delivery-only codes when necessary to distinguish separate and distinct multiple deliveries.

Cesarean-specific ruleNo additional allowance for subsequent newborns delivered via the same incision during cesarean; they are considered part of the initial cesarean delivery.

Modifier 22

PurposeModifier 22 indicates increased procedural services when maternity complications require substantial additional work beyond typical delivery services.

When to append