Medicaid Obstetric Claims Change Delayed

Thanks to TMA and its organized medicine partners, the Medicaid program delayed the start of changes to claims for obstetric services for one month until Oct. 1. At that time, claims with delivery procedure codes 59409, 59410, 59514, 59515, 59612, 59614, 59620, or 59622 will require the U1, U2, or U3 modifier.

Claims for deliveries following labor induction before 39 weeks of gestation that are not considered medically necessary will be denied.

The changes are legislatively mandated efforts to reduce the incidence of elective inductions before the 39th week of gestation. While TMA supports efforts to reduce nonmedically necessary inductions, it has expressed concerns to the Texas Health and Human Services Commission (HHSC) about the pace of changes. The association, together with state obstetrical and gynecological societies, has requested that HHSC postpone implementation until at least Oct. 1 to give practices more time to modify their claims-billing systems to meet the new requirements. The change was scheduled originally for Sept. 1.

For more information, call the Texas Medicaid & Healthcare Partnership Contact Center at (800) 925-9126.

Action, Aug. 15, 2011