March 27, 2023
Maternity Home Care Visits Coding
Thank you for being a Health Partners Plans participating provider and an active partner in our Baby Partners program. This program allows for home care visits by an in-network Home Care Agency to promote a healthy pregnancy and safe transition home for mom and baby. Here is a quick reference for the timeframes for these visits, and suggested ICD-10 codes based on ICD-10 CM guidelines for correct claims submission.
|
Visit |
Focus of Visit |
Procedure code |
Diagnosis code |
|
Prenatal complication |
Mother; use mother’s member ID |
99500 |
Use primary code for specific condition |
|
First visit preferably within the first 7 days post-delivery |
Mother; use mother’s member ID |
99501 |
Z39.2, routine postpartum follow-up |
|
Second visit between 7 and 84 days post-delivery |
Mother; use mother’s member ID |
99501 |
Z39.2, routine postpartum follow-up |
|
First visit preferably within 7 days for evaluation of baby only |
Baby; use baby’s member ID |
99502 |
Z00.111 if baby is under 28 days old; Z00.129 if baby is over 28 days old and normal findings; Z00.121 if baby is over 28 days old and abnormal findings |
PRIOR AUTHORIZATION FOR HOME CARE VISITS
Prior authorization is not required for these visits when performed by an in-network home care provider. For other services or if further visits are medically indicated, follow the usual procedure for obtaining prior authorization. Please fax requests for these home care services to 215-967-4491 by using the “Home Care Authorization Request Form” at HPPlans.com/forms under “Authorization Forms.”
If you have additional questions, please contact your Provider Relations Representative, or call our Provider Services Helpline at 1-888-991-9023, Monday – Friday, 9 a.m. – 5:30 p.m.