Welcome, Brokers!

Fidelis Care would like to remind providers of a postpartum visit incentive being offered through the New York State (NYS) Medicaid program and inform providers of extended claim submission dates. This program will provide an additional payment to the current NYS Medicaid reimbursement for comprehensive, timely postpartum visits provided to Medicaid Managed Care (MMC)/Fidelis Care Medicaid members.

Providers who delivered a person-centered comprehensive postpartum visit as outlined by the American College of Obstetricians and Gynecologists clinical guidelines, including a postpartum depression screen, to Fidelis Care members within 12 weeks of the date of delivery will receive an additional payment of $208.55.  One incentive payment is available per member/delivery combination.

Comprehensive postpartum visits are identified for the additional payment by CPT code "59430" - Postpartum Care Only (Separate Procedure) or if billing the bundled/global procedures codes (“59400”, “59410”, “59510”, “59515”, “59610”, “59614”, “59618”, “59622”, “59426”, and “59425”).

Providers using bundled/global procedure codes for billing will also be required to submit a separate claim with the non-payment Category II Current Procedural Terminology (CPT) code for perinatal services.  Providers must submit a claim for the postpartum visit with only the Category II Current Procedural Terminology code, as well as a $0.01 charge, to be considered for the incentive payment.

The following CPT II code should be used:

0503F             Postpartum Visit 

Providers that were unaware of the new billing guidelines, and previously submitted a claim for the bundled/global procedure code, can submit claims for the Category II CPT code to Fidelis Care by the dates listed below.  Postpartum visits originally billed with CPT code 59430, do not need to be resubmitted.

Please note: If you previously submitted a new or corrected claim related to the incentive billing requirement and received a rejection, please resubmit the affected claims accordingly.  Providers who have already submitted a corrected claim that includes both the bundled/global procedure code and the CPT II code do not need to take any further action.

In order to be eligible for the postpartum incentive please review your patient’s billing record, and if appropriate submit:

• A new or corrected claim for CPT code 59430 – Postpartum Care Only (Separate Procedure) or;
• A new or corrected claim (if bundled code was not previously billed) for the bundled/global procedures codes (“59400”, “59410”, “59510”, “59515”, “59610”, “59614”, “59618”, “59622”, “59426”, and “59425”).
  • If billing the bundled/global procedures above, also submit a new claim for CPT II Code -0503F

Please note: Claim submissions for the codes identified are intended to capture postpartum encounters for the NYS Medicaid Postpartum Incentive only.  For purposes of the incentive, claims received outside of the established business rules will be accepted, but no additional payments will be made by Fidelis Care.

Earned payments will be distributed following claim reconciliation to confirm a postpartum visit that meets the guidelines stated above was performed. Once payments are received by Fidelis Care from the state, those payments will be applied to the claims submitted during the applicable time period.

For the additional information on this direction, providers should refer to the Submission of Prenatal and Postpartum Service Claims for Each Pregnancy Related Visit article published in the December 2024 issue of the Medicaid Update.  

Questions should be directed to MaternalandChild.HealthPolicy@health.ny.gov

For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To find your designated representative, please visit Contact Your Designated Provider Relations Specialist.