OB Billing Codes Shift from Bundled to Unbundled in January
Beginning in January, physician billing codes for pregnancy care will transition from a bundled reimbursement model to fee-for-service billing for individual visits and services. Obstetricians say the new codes will more accurately capture variation in care delivery. However, the shift from global maternity packages to unbundled billing creates risk for overutilization and increased costs. Medicaid managed care organizations should review their maternity care contracts and utilization management protocols to address potential volume increases under the new coding structure.
The transition to unbundled OB billing could increase pregnancy care costs for MCOs through higher visit volumes and duplicative services unless utilization management and contract terms are adjusted.
Maternal · Managed Care · Finance
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