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Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook Updated to Clarify Delivery Modifier Requirement

Last updated on 12/14/2018

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

This is an update to the current Texas Medicaid Provider Procedures Manual, Volume 2, Gynecological, Obstetrics, and Family Planning Title XIX Services Handbook, subsection 4.1.2, “Vaginal and Cesarean Deliveries.” The language regarding the use of modifiers for the processing of delivery claims was revised and will be updated with the January 2019 release.

The following statements will be updated in the handbook section stated above:

  • The following procedure codes when submitted with the appropriate modifier may be a benefit for vaginal or cesarean deliveries:
Procedure Codes
59409 59410 59514 59515 59612 59614 59620
59622 S8415*          
* Procedure code S8415 is for home delivery supplies
  • The following modifiers must be billed with the procedure codes indicated above for vaginal and cesarean deliveries:

Modifiers

U1

Prior to 39 Weeks and Medically Necessary

U2

39 Weeks or Later

U3

Prior to 39 Weeks and Not Medically Necessary

For more information, call the TMHP Contact Center at 800-925-9126.