Home birth coding requirements

Include the mother and newborn's Kaiser Permanente member ID numbers when billing for newborn services. If you have questions about claims submission or payment, contact the Provider Assistance Unit (PAU).

We require standard CPT-4 coding and obstetrics (OB) coding policy rules as defined in the American Medical Association's (AMA) CPT-4 coding manual. This applies to the following services:

Prenatal
Delivery
Postpartum

Exceptions include:
Certain newborn care
Home-based care
Urgent/emergent transfer services
Situations where there is a split in coverage or care

CMS 1500 and UB-92 forms must be coded to the most specific level of diagnosis to be considered valid. For example, if a base ICD-10 code has extended characters (that is, four, five, six, or seven), you must code to the final character. The Centers for Medicare and Medicaid Services (CMS) will not allow, nor may Kaiser Permanente pay claims, lacking the extended characters.

Note: All coding in this section is subject to change based on annual CPT-4 coding updates.

Maternity services

Use maternal care and delivery codes 59400-59430 for antepartum, delivery, and postpartum services. Evaluation and management codes should be used only if the patient had one to three antepartum visits and no further care. All OB coding rules apply. Providers should bill with the most appropriate global code.

Use labor management code 99354 or CMS POS Code 11 or 12 only when you must transfer your patient from home or a birth center to a hospital for delivery. We will deny code 99354 if you bill it with codes 59400 through 59410.

When you perform a delivery, labor management is part of your global midwifery services (codes 59400 through 59410). We do not recognize CPT-4 code 59899 for any labor management services associated with routine intrapartum and delivery care in the home or at a birth center. Do not bill code 59899 under these circumstances.

Newborn care services

Use the mother and newborn's Kaiser Permanente member ID numbers when billing for newborn services.

CMS POS Code 11, 12, 21 or 25

Code 99461: Covers initial newborn exam and care when performed in the home.
Code 99460 or 99463: Covers initial newborn exam and care when performed in a birth center.
Code 99465: Use for newborn resuscitation, use of positive pressure, ventilation, or chest compressions (see CPT-4 manual).

HCFS POS Code 11 or 12

Code 99461: Use for follow-up newborn home visit.

Medicaid coding

Kaiser Permanente will not accept Medicaid coding for maternity services, including any Medicaid high-risk or facility codes. We will deny any services billed using these codes.

Birth center deliveries

Code 59400 and SG modifier: Only under certain exceptional circumstances will we cover birth center facility fees.