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December 2016 Texas Medicaid Provider Procedures Manual

Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook : 3 Obstetric Services : 3.1 *Services, Benefits, Limitations, and Prior Authorization : 3.1.14 Birthing Centers—Professional Services

3.1.14
The following procedures may be performed by professionals in the birthing center setting:
 
The following table includes procedure codes that may be benefits for licensed midwife (LM) services rendered in the birthing center setting:
 
Note:
Antenatal services provided by LMs may be a benefit when billed with modifier TH. If the client is discharged prior to delivery, procedure codes 99218, 99219, or 99220 may be billed by the professional for labor services only. Clinical documentation that clearly demonstrates level of medical decision making (i.e., moderate or complex) must be included in the client’s medical record. All medical documentation is subject to retrospective review. Those services not supported by the documentation in the client’s medical record are subject to recoupment.
Refer to:
Subsection 9.2.44, “Newborn Services” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks) for more information related to the care of the newborn.

Texas Medicaid & Healthcare Partnership
CPT only copyright 2014 American Medical Association. All rights reserved.