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TO: All
Maternity Care Providers (MCPs)
RE: Additional
Postpartum Bonus Payment Opportunity
Effective
October 1, 2024, Maternity Care Providers (MCPs) have an opportunity to earn an
additional maternity postpartum bonus payment worth a total of $250 per
recipient. MCPs who see recipients between 7-21 days post-delivery or end of
pregnancy may qualify to receive a $125 postpartum bonus payment. MCPs who see
recipients between 22-84 days post-delivery or end of pregnancy may qualify to
receive an additional $125 postpartum bonus payment.
Effective
October 1, 2024, MCPs are reimbursed for the specified MCP bonus payments at
the following rates:
|
Procedure
Code
|
Description
|
Rate
(for all MCP providers)
|
|
H1000
|
Prenatal Visit Bonus
|
$150
|
|
G9357 (with U1 modifier)
|
Postpartum Visit Bonus (between 7-21 days)
|
$125
|
|
G9357 (with U2 modifier)
|
Postpartum Visit Bonus (between 22-84
days) *
|
$125
|
*To qualify for both postpartum bonus payments, there
must be at least 14 days between the first and second postpartum visits
Physicians
are reimbursed at 100% for the MCP bonus payments. Nurse practitioners,
physician assistants, and nurse midwives are reimbursed 80% of the physician
rate for the MCP bonus payments.
The prenatal bonus payment may be eligible to providers who render
services to pregnant recipients within 90 days of the last menstrual period.
The postpartum bonus payments may be eligible to providers who render services
to recipients between 7-21 days and/or 22-84 days after delivery or end of
pregnancy. The MCP bonus payment procedure codes must be billed on a separate
claim for reimbursement. Modifiers are necessary on the postpartum bonus
payment claims. For billing instructions, please refer to Chapter 24 of the
Medicaid Provider Billing Manual. You may also view the recorded webinars from
September 2024 which provided an introduction and overview of the new Alabama
Coordinated Health Network (ACHN) changes effective October 1, 2024. The
maternity care updates can be accessed at the link below.
Email
questions related to the MCP bonus payments outlined above to ACHN@medicaid.alabama.gov.
The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2024 American Medical Association and © 2024 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.