Billing and Reimbursement Guidelines
Additional maternity payments
Through our Maternity Care Program, our network obstetric providers can earn payments on top of regular reimbursements for maternity care.
Getting paid is easy. This chart outlines how to get the extra payments:
| Type of Visit | Prenatal | Postpartum | Mental Health Screening |
| Timeframe for visit | During the first trimester of pregnancy or within 42 days of the patient's BlueCare Tennessee or CoverKids enrollment | Within seven to 84 days of delivery | At least once during the perinatal period using a standardized tool for depression and anxiety |
| Steps to Receive Payment | Bill the visit using category II code 0500F, and please remember to:
| Bill the visit using category II code 0503F, and please remember to:
Note: We'll allow for reimbursement of two claims for code 0503F during the 84-day postpartum period. | Bill CPT® 96160 with a TH modifier to show you completed the service, and please remember to:
Note: No specific diagnosis code is required for payment. |
| Reimbursement | $25 per patient | $75 per patient/per claim | $28.35 per patient |
*All other billing and processing guidelines apply, including prior authorization requirements, coordination of benefits and timely filing. Additionally, all claims submitted are subject to retrospective claims review and possible recovery. For more information about billing guidelines, please see the BlueCare Tennessee Provider Administration Manual.
*Review detailed sample billing guidance and scenario-specific instructions on billing 0500F here.
Lactation Consultant Benefits
Help with breastfeeding
Effective June 1, 2023, your patients with BlueCare℠, TennCareSelect and CoverKids coverage have lactation benefits. These benefits include medically appropriate lactation consultant services from in-network providers during pregnancy and the extended postpartum period. Parents can get services through telehealth or in person in a one-on-one or small group setting.
