Billing Requirements for Elective C-sections and Induction of Labor
Contracts affected: Commercial
We are aligning with Medicaid’s billing requirements for elective obstetric deliveries.
All inpatient elective delivery claims for our commercial members must be submitted with a condition code to identify the gestational age of the fetus. Claims submitted without a condition code will be denied.
Beginning March 1, 2020, we will reimburse hospital facilities at 100% for inpatient elective deliveries (C-sections and inductions of labor) performed at less than 39 weeks with medical necessity. If performed electively, without medical necessity, we will reimburse 25% for C-sections or inductions.
Please follow the below coding guidance to prevent claim denials.
Coding Guidelines for Facility Claims:
Condition codes will be required for any elective deliveries.
This includes ICD-10 procedure codes: 10900ZC, 10903ZC, 10904ZC, 10907ZC, 10908ZC, 3E030VJ, 3E033VJ, 10D00Z0, 10D00Z1, 10D00Z2, 3E0P7GC, and 0U7C7ZZ.
||C-sections or inductions performed at less than 39 weeks gestation for medical necessity (full payment)|
|82||Gestation less than 39 weeks, elective C-section or induction (payment of 25%)|
|83||Gestation 39 weeks or longer (full payment)|
Working with Us
We want to hear from you! Have a topic request for the next Blue Bulletin? Email us
Stay in Touch! Sign up to receive emails for provider news and information