In May, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) published a reminder for providers outlining how to bill antepartum codes when the provider does not bill for global maternity services (Reimbursement Policy Reminder: Antepartum Visit CPT Codes | Blue Cross NC).

This article explains how to bill correctly for an initial prenatal care visit and a postpartum care visit in accordance with HEDIS guidelines when a provider is filing a global claim. Both instructions are part of our Maternity Reimbursement Guidelines, established in 2021. View these guidelines here.

HEDIS Quality Reporting for Initial Prenatal and Postpartum Visit

Blue Cross NC recognizes that prenatal and postpartum visits are an important part of a healthy pregnancy journey. As a reminder, these visits should be submitted separately from the global maternity claims as documented below.

Quality Reporting is part of our Guidelines for Global Maternity Reimbursement | Providers | Blue Cross NC.

Quality Reporting

In support of quality tracking and in accordance with HEDIS guidelines, we require that separate claims be submitted for the following:

• Date of First Prenatal Visit
  Submit a claim reflecting the actual date of the first visit for prenatal care in first trimester OR within 42 days of plan enrollment. 
• First Prenatal Visit Coding

AND any of the following applicable diagnosis codes

• Date of Postpartum Visit(s)
  In accordance with HEDIS reporting requirements, the postpartum visit(s) should occur between 1-12 weeks after delivery. Submit a claim with the actual date the postpartum service was rendered.
• Postpartum Visit Coding

AND

Blue Cross NC remains committed to working with our OB-GYN providers to uphold proper billing practices, ensuring fair and accurate reimbursement while preventing unnecessary payment errors. 

This policy applies to Commercial, Inter-Plan Program (IPP) Host, Medicare Advantage, and Federal Employee Program (FEP) plans. This does not apply to IPP Home.

Reimbursement Policy Reminder: Antepartum Visit CPT Codes

As a reminder, the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) reimbursement policy regarding antepartum, delivery, and postpartum care under routine maternity services was established in 2021. View the full policy here, specifically Section IV. 

Providers must ensure that antepartum codes—particularly 59425 and 59426—are billed only once per provider or provider group, based on the billing FTIN. These codes should only be used when the provider does not bill for global maternity services. Duplicate billing for these codes will not be reimbursed. 

Blue Cross NC remains committed to working with our OB-GYN providers to uphold proper billing practices, ensuring fair and accurate reimbursement while preventing unnecessary payment errors. 

This policy applies to Commercial, Inter-Plan Program (IPP) Host, Medicare Advantage, and Federal Employee Program (FEP). This does not apply to IPP Home.