10.3 Benefits and LimitationsBirthing centers, using their nine-digit provider identifier, can only submit claims for their facility services (e.g., labor and delivery services). The maternity clinic, physician, CNM, nurse practitioner (NP), clinical nurse specialist (CNS), or physician assistant (PA) performing services must submit separate claims for their services because the services they provide (e.g., prenatal, family planning) are not approved birthing center services. The Texas Medicaid Program reimburses procedure codes 1-99431 and 1-99432 when performed in the birthing center and billed by a physician or CNM. Procedure code 1-99433 is not payable when performed in the birthing center. Childbirth education classes and the use of a documented midwife as the birth attendant are not benefits of the Texas Medicaid Program. The following table lists the allowable procedure codes for birthing center services with the corresponding maximum fees:
Health and Safety Code, Chapter 47, requires birthing centers located in a county with a population of more than 50,000 and that has 100 or more births per year to offer all newborns a hearing screening as a part of the obstetrical care at delivery. For more information regarding newborn hearing screening contact:
DSHS Refer all newborns who have abnormal screening results to a local PACT provider for follow-up care. PACT provides services and hearing aids for children ages birth through 20 years of age who have permanent hearing loss and are Medicaid-eligible. Traditional Medicaid providers are reimbursed for the diagnosis and treatment of abnormal hearing screen follow-up when a local PACT provider is not available. Providers must use procedure codes 5-92585, 5/I/T-92587, and 5/I/T-92588 when billing for follow-up diagnosis of abnormal hearing screens. Refer to: "Certified Nurse-Midwife (CNM)" . |
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Texas Medicaid & Healthcare Partnership CPT only copyright 2007 American Medical Association. All rights reserved. |
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