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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

August 2018

Home Care Providers: Billing for Postnatal Skilled Nursing Home Visits

Harvard Pilgrim would like to provide some clarification regarding the correct method of billing for postnatal home health visits for skilled nursing care, to ensure that the correct cost sharing applies and the claim is appropriately processed.

When submitting a claim for the postnatal assessment due to early maternity discharge for a member of any Harvard Pilgrim plan, bill CPT code 99501 (Home visit for postnatal assessment and follow-up care) along with revenue code 0551 (Skilled Nursing, visit charge, per visit up to 2 hours). Please keep in mind that CPT code 99501 has a benefit limit of one per pregnancy.

Providers can bill 99501 with revenue code 0551 for the postnatal home assessment for early maternity discharge (up to two hours) only. Billing CPT code 99501 for any visits beyond the first one will result in a denial of the claim. For any follow-up postnatal skilled nursing visits, please bill revenue code 0551 only.

Harvard Pilgrim’s Home Health Care Payment Policy has been updated to provide greater clarity around billing for postnatal skilled nursing home health visits. Refer to the “Other Information” section of the policy for specific billing instructions.

Please remember that you have the option to submit replacement claims for any corrections that need to be made. While you can submit replacement claims electronically or on paper, Harvard Pilgrim recommends the electronic submission process for its ease of use, quick turnaround time, and claims tracking capability. For more information, refer to our Replacement Claim Billing.

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