Global Maternity Claims
Global maternity involves the billing process for maternity-related claims
for a beneficiary. Once a beneficiary has been diagnosed as
pregnant, all charges related to the pregnancy are grouped under one
global maternity diagnosis code.
These diagnosis codes will be listed as the primary diagnosis when
billing. Figure 8.1 on the following page lists examples of these codes.
Global
Maternity Diagnosis Code Examples
V22 Normal
pregnancy
V22.0 Supervision of
normal first pregnancy
V22.1 Supervision of
other normal pregnancy
V22.2 Pregnant state,
incidental
When beneficiaries are
referred for specialty obstetric care, prior authorization must be obtained
Maternal Serum Alpha
Fetoprotein and Multiple Marker Screen Test are cost-shared separately (outside the global
fee) as part of the maternity care benefit to predict fetal developmental abnormalities or genetic
defects. A second phenylketonuria test for infants is allowed if administered one to
two weeks after discharge from the hospital as recommended by the American Academy of
Pediatrics®.
Professional and
technical components of medically necessary fetal ultrasounds are covered
outside the maternity global fee.
The medically necessary indications include (but are not limited to)
clinical circumstances that
require obstetric ultrasounds to estimate gestational age, evaluate fetal
growth, conduct a biophysical
evaluation for fetal well- being, evaluate a suspected ectopic pregnancy, define the cause of
vaginal bleeding, diagnose or evaluate multiple gestations, confirm
cardiac activity, evaluate
maternal pelvic masses or uterine abnormalities, evaluate suspected
hydatidiform mole, and evaluate the
fetus’ condition in late registrants for prenatal care.
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