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

October 2016

Reminder: Billing for Additional Antepartum E&M Visits

Harvard Pilgrim has updated our Obstetrical/Maternity Care Payment Policy to provide greater clarity, and would like to remind providers of our policy regarding the submission of claims for additional antepartum evaluation and management (E&M) visits.

If you wish to bill for additional visits due to pregnancy complications — i.e., exceeding the typical 14 visits covered for routine care under Harvard Pilgrim’s global obstetrical package — Harvard Pilgrim requires that you append modifier 22 to the appropriate global obstetrical code: CPT 59400, 59510, 59610, or 59618. In addition, in order for your claim to be considered for reimbursement, you must submit all medical documentation (such as progress notes and/or the antepartum flow sheet) to support the medical necessity of the additional visits.

While claims for additional visits may be given individual consideration for reimbursement, individual claims for E&M services will not be accepted if they are submitted prior to the delivery, as the appropriate number of visits can only be determined after the actual delivery occurs.

For more information, please refer to Harvard Pilgrim’s updated Obstetrical/Maternity Care Payment Policy.

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Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,

Joseph O'Riordan,

Kristin Edmonston,
Production Coordinator