Date: February 21, 2023
To: Enrolled Physicians; Physician Assistants; and Advanced Practice Registered Nurses
Re: Maternity Codes Rate Increases per Public Act 102-1037 and Bonus Payments for Certain Postpartum Visits Effective January 1, 2023
This notice informs enrolled physicians, physician assistants, and advanced practice registered nurses of prenatal and postpartum visit and external cephalic version (ECV) rate increases in accordance with Public Act 102-1037. These rate increases are effective with dates of service beginning January 1, 2023, pending approval by the federal Centers for Medicare and Medicaid Services (CMS). The Department of Healthcare and Family Services (HFS) is also pursuing bonus payments for postpartum visits meeting specific timelines. These payment changes apply to services for customers covered under the Medicaid fee-for-service (FFS) program and the HealthChoice Illinois (HCI) managed care organizations (MCOs).
Effective with dates of service beginning January 1, 2023:
- Prenatal and postpartum visits will be increased to no less than the rate for an adult well visit, including any applicable add-ons.
- Reimbursement rates for ECV will be increased to 100% of the Medicare rate.
- Bonus payments for certain postpartum visits will be introduced. These bonus payments will be reimbursed at a rate of $75 per visit and are dependent upon HFS having a delivery date on the postpartum visit claim. Providers must include the actual delivery date in the Loop 2300, DTP*454 'Initial Treatment Date' segment, of the 837P. Medical Electronic Data Interchange (MEDI) system changes are underway to collect the actual delivery date on a direct data entry (DDE) claim. The provider is eligible for bonus payments if a postpartum visit is within the first 26 days following the delivery date on file, and another within 27-89 days following the delivery date on file. Each time period will have a limit of one payable bonus payment. For instances when more than one claim is received during each of those time periods, the bonus payment will be reimbursed on the first claim received.
The table below identifies the specific prenatal, postpartum, and ECV procedure codes affected by the rate increases.
|Procedure Code||Description||Rate Effective January 1, 2023||Eligible for Bonus Payment|
|0500F||Initial prenatal visit||$104.96||No|
|0502F||Subsequent prenatal visit||$104.96||No|
|0503F||Postpartum care visit||$88.57||Yes|
|59430||Postpartum care visit||$88.57||Yes|
Please Note: HFS is required to receive federal CMS approval for both the rate increases and postpartum visit bonus payments prior to reimbursement in the FFS program.
- System changes are in progress to accurately assign the postpartum visit bonus payments.
- Claims containing the postpartum visit and ECV codes will be placed on hold until both federal approval and programming updates are completed.
Providers will be informed via a provider notice when CMS has approved the rate updates and bonus payments and the bonus payment programming is finalized. Held claims will also be released for adjudication at that time. Providers will need to submit replacement claims for any services billed prior to this notification of the delivery date reporting instructions and reimbursed without a bonus payment prior to federal approval and system rate updates.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565 for FFS customers or the applicable HCI MCO.
Kelly Cunningham, Administrator
Division of Medical Programs