The original article included the following statement:

“In the office, outpatient hospital, and birthing center setting, physicians (obstetricians, family practice physicians, and maternal-fetal medicine specialists), certified nurse midwives (CNMs), and maternity service clinics (MSCs) are limited to 20 antepartum care visits and two postpartum care visits per pregnancy. Normal pregnancies are anticipated to require around 11 visits per pregnancy, and high-risk pregnancies are anticipated to require around 20 visits per pregnancy. If more than 20 visits are medically necessary, the provider can appeal with documentation supporting pregnancy complications. The high-risk client’s medical record documentation should reflect the need for increased visits and is subject to retrospective review.”

To clarify, physicians (obstetricians, family practice physicians, and maternal-fetal medicine specialists), CNMs, and MSCs are limited to 20 outpatient antepartum care visits and two postpartum care visits per pregnancy. These visits should be billed using the most appropriate new or established antepartum visit code or postpartum visit code:

Important: The first visit may be billed using a new-patient-visit procedure code only if no other professional service has been provided to the client by that provider or a provider of the same specialty in the same group practice within the past three years (36 months). All subsequent visits must be billed using an established patient procedure code even if the visit is for a different pregnancy.

Providers may refer to the 2009 Texas Medicaid Provider Procedures Manual, section 36.4.39.6, “Office or Other Outpatient Hospital Services,” on page 36-102, for more information about the new-patient visit.

The original article indicated that the following procedure codes must be billed together:

To clarify, the procedure codes related to multiple pregnancies (the left column) are reimbursable only if the corresponding procedure codes related to single pregnancies (the right column) have been billed.

·         Procedure code 76810 may be reimbursed when procedure code 76805 has been billed.

·         Procedure code 76812 may be reimbursed when procedure code 76811 has been billed.

·         Procedure code 76814 may be reimbursed when procedure code 76813 has been billed.

The original article stated that procedure code 76816 must be billed with modifier 76 for each additional fetus examined in a multiple pregnancy. To clarify, procedure code 76816 must be billed without modifier if there is one fetus or for the first fetus in a multiple pregnancy. Procedure code 76816 must be billed with modifier 76 for each additional fetus in a multiple pregnancy to indicate a repeat service provided.