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Billing Requirements for Elective C-sections and Induction of Labor

November 26, 2019

To: Hospitals

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.

Condition codes

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)

Beginning March 1, 2020, please include condition codes as required.


If you have any questions regarding this information, please contact Provider Service at 1-800-950-0051 or (716) 884-3461.

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