Maternity Services
Defines billing, coding, modifier use, documentation, and claim submission requirements for maternity/obstetrical care (antepartum, delivery, postpartum) affecting providers submitting claims to Priority Health.
For patients beginning prenatal care in June 2026, antepartum services shall be reported based on the number of visits rendered with E/M codes for 1-3 visits and specific antepartum codes for 4+ visits; TH modifier required for 1-3 visit E/M reporting.
Requirement to include all prenatal dates on the claim in box 19; failure to do so will result in denial.
Diagnosis sequencing restriction: cesarean delivery procedures will not be reimbursed when billed with O82 and gestational age <39 weeks.
Modifiers 76 and 77 were added to the list of applicable modifiers for maternity billing.
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