Payment Reductions on Elective Delivery (C-Section and Induction of Labor) Less than 39 Weeks without Medical Indication
3/9/2020
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Posted by Provider Relations
As a reminder, Fidelis Care will reduce payment for early elective deliveries without an acceptable medical indication. Claims for elective deliveries prior to 39 weeks, without medical indication, will be reduced as per New York State Medicaid policy. The penalty reflects the Medicaid Program's commitment to providing high quality prenatal care by ensuring appropriate delivery for both mothers and babies. The penalty amount will be a reimbursement rate of 25% of the C-section fee schedule allowed amount.
Additionally, for medical claims modifiers U7, U8 or U9 will continue to be required for all deliveries and claims for hospital inpatient stays associated with a delivery will continue to require a condition code 81, 82 or 83 for payment. Failure to include the appropriate modifiers and/or condition codes will result in claim denials.
For further information, refer to our provider manual, Section 12 – Part 2, starting on page 12.2.6 Obstetric Delivery Billing Requirements