Post by Tanya Munroe on Jun 21, 2016 11:36:27 GMT -5
OH Potential Primary Care Billing Codes 2016.docx (20.25 KB)
Attached is a document that has the Ohio Medicaid codes pertaining to pregnancy care. The S codes related to “group visits” are highlighted in yellow. In addition, below is the relevant section of Ohio Administrative Code (can be found at: codes.ohio.gov/oac/5160-4-10) that defines the care setting, etc.
(C) Group pre-natal at-risk education
(1) Group education classes on a variety of topics relating to pregnancy, birth, childcare, nutrition, family and support systems are covered on a per class basis. (E.g., Lamaze or other childbirth classes would be considered a covered group education service).
(2) Group education may be a single class covering a single topic or multiple topics or it may be a series of classes covering a single topic or multiple topics.
(3) Group education classes must consist of a face-to-face presentation by a medical professional in a group of no more than twelve patients (not including partners/coaches).
(4) For reimbursement, the provider must bill the appropriate code listed in this paragraph to indicate the type of group session attended by the recipient. The unit of service for each session (one or more classes) is limited to one per pregnancy. The following group education sessions for pregnancy session are covered by medicaid effective with services provided on and after the effective date of this rule:
(a) For childbirth preparation/Lamaze classes, non-physician provider, per session, bill S9436.
(b) For childbirth refresher classes, non-physician provider, per session, bill S9437;
(c) For nutrition classes provided to pregnant women by a non-physician provider, per session, bill S9452.
(d) For baby parenting classes provided to pregnant women by a non-physician provider, per session, bill S9444; and
(e) For infant safety classes provided to pregnant women by a non-physician provider, per session, bill S9447.
Attached is a document that has the Ohio Medicaid codes pertaining to pregnancy care. The S codes related to “group visits” are highlighted in yellow. In addition, below is the relevant section of Ohio Administrative Code (can be found at: codes.ohio.gov/oac/5160-4-10) that defines the care setting, etc.
(C) Group pre-natal at-risk education
(1) Group education classes on a variety of topics relating to pregnancy, birth, childcare, nutrition, family and support systems are covered on a per class basis. (E.g., Lamaze or other childbirth classes would be considered a covered group education service).
(2) Group education may be a single class covering a single topic or multiple topics or it may be a series of classes covering a single topic or multiple topics.
(3) Group education classes must consist of a face-to-face presentation by a medical professional in a group of no more than twelve patients (not including partners/coaches).
(4) For reimbursement, the provider must bill the appropriate code listed in this paragraph to indicate the type of group session attended by the recipient. The unit of service for each session (one or more classes) is limited to one per pregnancy. The following group education sessions for pregnancy session are covered by medicaid effective with services provided on and after the effective date of this rule:
(a) For childbirth preparation/Lamaze classes, non-physician provider, per session, bill S9436.
(b) For childbirth refresher classes, non-physician provider, per session, bill S9437;
(c) For nutrition classes provided to pregnant women by a non-physician provider, per session, bill S9452.
(d) For baby parenting classes provided to pregnant women by a non-physician provider, per session, bill S9444; and
(e) For infant safety classes provided to pregnant women by a non-physician provider, per session, bill S9447.