Harvard Pilgrim Health Care Home
  HPHConnect
 
  Learn more.
  Sign up for HPHConnect.
Medical Management
E-Transactions
HPHConnect
Pharmacy
For Your Patient
News Center
Network Matters
Newsletter Archives
Newsletter Registration
Newsroom
Office Support
Products
Provider Manual
Medicare Advantage
Research & Teaching
Resources & Links
 
Print    Text Size

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.

Email this article to a colleague   


Network Matters Archives

Download printer-friendly version

HPHCURRENT EVENTS

Harvard Pilgrim Among NCQA’s Highest-Rated Private Health Plans in the U.S.

Medicare Advantage Updates: Expansion and Prior Authorization Policies

Harvard Pilgrim Introduces ElevateHealth Options in New Hampshire

Habilitative Benefit Requirement and Rehabilitative Benefit Changes

CLINICIAN CORNER

Medicare Prescriber Enrollment Deadline Updated

Reminder: Billing for Additional Antepartum E&M Visits

2017 CPT and HCPCS codes

Update to Formulas and Enteral Nutrition Prior Authorization Policy

Updates to Cardiovascular Disease Risk Tests Policy

Medicare Advantage Blood Glucose Monitoring Supplies

P&T Committee Updates

Specialty Pharmacy Program Updates

Updates to Clinical Medical Policies

ADHD Diagnosis and Follow-up Care

OFFICE ASSISTANT

Outpatient Fee Schedule Updates

Assisting our Nurse Case Managers with Requests for Information

Keep Panel Status and Demographic Information Up to Date

PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Robert Farias,
Vice President, Network Services

Annmarie Dadoly,
Editor

Joseph O'Riordan,
Writer

Kristin Edmonston,
Production Coordinator