TMPPM 2010 > Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook > Physician > Procedures and Services > Newborn Services

6.3.38 Newborn Services

The newborn period is defined as the time from birth through 28 days of life. This section addresses routine newborn care, attendance at delivery, newborn resuscitation, neonatal critical care, and intensive (noncritical) low birth weight services.

Retrospective review may be performed to ensure documentation supports the medical necessity of the service and any modifier used when billing a claim.

Modifier 25 may be used to identify a significant separately identifiable E/M provided on the same day by the same physician as a procedure or other service. When billing with Modifier 25, the provider must provide documentation to substantiate the use of the modifier in order for services to be reimbursed. Documentation includes, but is not limited to, office or hospital medical records, such as history and physical progress notes, and lab results, if applicable.

Physician standby (procedure code 99360) is not a benefit.

Note: Some of the services addressed in this section may also be used for care beyond 28 days of life.

Refer to: Subsection 6.3.50, "Physician Evaluation and Management (E/M) Services" in this handbook for E/M services for newborns.

Subsection 3.5.4, "Cardiorespiratory (Apnea) Monitor" in Children's Services Handbook (Vol. 2, Provider Handbooks) for authorization of apnea monitors through CCP.

Subsection 6.3.38.6, "Newborn Hearing Screening" in this handbook.