CPT II obstetrical billing information

We know you work hard to ensure our members receive the care they need. Anthem Blue Cross and Blue Shield Healthcare Solutions added two additional billing codes in order to more accurately reflect the services our members are receiving. Beginning March 1, 2017, CPT^® Category II (CPT II) procedure codes were introduced to be used in addition to obstetric codes for verified live births. CPT II codes are nonreimbursable codes used for tracking obstetrical care.

 

Why is this change necessary?

Women’s health is important to us as well as to the state of Nevada. As a provider, you play an important role in ensuring our members obtain the care they need.

 

How does this impact me?

• Members should have a prenatal visit within the first trimester, on or before the enrollment start date or within 42 days of enrollment.
• Your office should schedule a postpartum visit on or between 7 and 84 days after delivery.

 

Prenatal and postpartum care
CPT II codes
0500F	Initial prenatal care visit — report at first prenatal encounter with health care professional providing obstetrical care, also report date of visit; in a separate field, report the date of the last menstrual period.
0501F	If Prenatal Care flow Sheet documented in medical record by first prenatal visit.
0502F	Subsequent prenatal care visit
0503F	Postpartum visit — to be completed from 7 to 84 days after delivery
CPT codes (CPT II codes must be billed with one of these global billing codes.)
59400	Routine obstetric care (ROC) including antepartum care (AC), vaginal delivery (VD) and postpartum care (PC)
59510	ROC including AC, cesarean delivery (CD) and PC
59610	ROC including AC, VD and PC after previous CD
59618	ROC including AC, CD and PC after attempted VD following previous CD
If a member does not qualify for global obstetrical billing, the CPT II codes should still be used to reflect prenatal and postpartum visits.

 

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your Provider Relations representative or call Provider Services toll-free at 1-844-396-2330.

 

ANV-NU-0118-20 March 2020