OB Billing Codes Shift from Bundled to Fee-for-Service in January
Starting in January, physician billing codes for pregnancy care will change from a bundled payment structure to individual fee-for-service codes. Obstetricians say the new à la carte approach will better reflect the actual care delivered, but the shift may create incentives for providers to increase the number of visits and services. The change affects how managed care organizations pay for and manage maternity care, a significant cost driver in Medicaid programs that cover approximately 42% of all U.S. births. MCOs will need to update payment methodologies, utilization management protocols, and monitor for potential overutilization.
The shift from bundled to unbundled maternity billing could increase costs and utilization, requiring MCOs to update payment models, strengthen utilization review, and adjust actuarial assumptions for a benefit category that accounts for a substantial portion of Medicaid spending.
Maternal · Managed Care · Finance
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