Skip to main content

Billing Requirements for Elective C-sections and Induction of Labor

Date:
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

81 
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.

Recent Articles

  • Individual Provider Recontracting Initiative
    We will be amending and restating our existing contracts. Starting next month, all directly contracted individual providers will be sent an updated contract. The New York State Department of Health (DOH) requires that each provider sign and return their amended/restated contract.
  • New Digital Provider and Facility Reference Manual
    We’ve upgraded our Provider and Facility Reference Manual, which is now available in digital format. The new manual offers a better, more interactive user experience. Here, we highlight some of the new features.
  • Updates to Screening for Hepatitis C Virus (HCV) in Adults
    Hepatitis C virus (HCV) is reportedly the most common blood infection in the country. The U.S. Preventive Services Task Force has updated the recommendation for HCV screening in March 2020 to now include all adults ages 18 to 79 without known liver disease, regardless of their risk for infection.
  • Update to Spine Preauthorization Process
    To help streamline the preauthorization process for spine procedures and injections, all these requests will be submitted directly to our Utilization Management Department beginning October 1, 2020. We will no longer require any requests to be submitted through Palladian Health.
  • Care at Home Expanded for Medicare Advantage Patients
    Beginning on July 7, more Medicare Advantage patients will be eligible to enroll in a new extension of the Care at Home program -- Care at Home℠ On Call -- which offers some urgent care in-home services. Care at Home On Call will be offered to newly enrolled Medicare Advantage members.

Working with Us

Additional Resources

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