Tuesday, September 24, 2019

CPT H1000, H1001, H1004 - Prenatal and postpartum services

HCPCS code and Description

H1000 Prenatal care, at-risk assessment
H1001 Prenatal Care, At Risk Enhances Service;
H1004 Prenatal Care, At-Risk Enhanced; Follow Up Home Visit

FPC–Frequency of prenatal care

Prenatal standalone visits CPT codes:  99500, 0500F, 0501F, 0502F    
HCPCS Code : H1000-H1004   and H1005

The percentage of expected prenatal visits based on weeks of gestation at delivery and months of pregnancy when patient enrolled in Medicaid:

• Every four weeks for the first 28 weeks of pregnancy
• Every two-three weeks for the next seven weeks
• Weekly thereafter until delivery


Prenatal and Postpartum Care (PPC)

The percentage of deliveries of live births on or between November 6 of the year prior to the measurement year and November 5 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care.

• Timeliness of Prenatal Care. The percentage of deliveries that received a prenatal care visit as a member of the organization in the first trimester, on the enrollment start date or within 42 days of enrollment in the organization.

• Postpartum Care. The percentage of deliveries that had a postpartum visit on or between 21 and 56 days after delivery.


UHC Florida Guidelines
** Prenatal care must be billed separately from the delivery and postpartum care.
** FL providers are to submit prenatal codes H1001 and/or H1000.
** Up to 14visits are allowed for prenatal care& up to 18 visits are allowed for high risk prenatal care.
** Up to 3postpartum visits are allowed within 90 days following delivery, per recipient.
** Delivery of two or more infants from a single pregnancy, by different delivery method, separately.  Same delivery method is non-covered.

Per Florida State Requirements, Birthing Centers (POS 25) are reimbursed the facility fee with procedure code 59409 and Provider delivery services in a birthing center with code 59410


Prenatal and Postnatal Home Visits   - Medicaid insurance billing

Home visits can be included in the management plan of pregnant members when there is a need to assess the home environment and its implications for the management of prenatal and postnatal care; to provide direct care; to encourage regular visits for prenatal care; to provide emotional
support; and to determine educational needs.

Visits may be provided by one of the following Utah licensed qualified providers:
**  Registered Nurse
**  Certified Nurse-Midwife   
**  Certified Nurse Practitioner
**  Social Service Worker
**  Certified Social Worker
**  Licensed Practical Nurse, who works under the supervision of a registered nurse and has additional training and experience to be a perinatal care coordinator
**  Health Educator must have either a Bachelor’s degree in health education with a minimum of three years’ experience, at least one of which must be in a medical setting, a Master’s degree with a minimum of one year of experience working in a medical setting or with pregnant women, or a Bachelor’s degree and a certificate showing completion of a certification examination in health education.

The service is reported using HCPCS H1004 Prenatal Care, At-Risk Enhanced; Follow Up Home Visit.  Limited to six visits during a 12-month period.


Risk Assessment  


Risk assessment is the systematic review of relevant member data to identify potential problems and determine a plan for care.  Early identification of high risk pregnancies with appropriate consultation and intervention contributes significantly to an improved perinatal outcome and lowering of maternal and infant morbidity and mortality.   A care plan for high risk members, in addition to standard care, includes referral to or consultation with an appropriate specialist, individualized counseling and services designed to address the risk factor(s) involved.  A care plan for low risk members includes primary care services and additional services specific to the needs of the individual. 

Risk Assessments may be provided by one of the following licensed Medicaid providers:

**  Physician
**  Certified Nurse Practitioner
**  Certified Nurse-Midwife

The service is reported using HCPCS H1000 Prenatal Care, At Risk Assessment for a low risk assessment or HCPCS H1001 Prenatal Care, At Risk Enhances Service; Antepartum Management for high risk assessment.  Limited to two (2) assessments during any 10-month period.


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