Insurance billing can be daunting with running your own midwifery practice. It is easy to bill for services with cash, but many families are very dependent on getting their insurance to pay for care. Especially maternity and newborn care since the Affordable Care Act legally requires insurance companies to cover preventative care.
Midwives that deliver in the hospital typically don’t do newborn care (pediatrician on call covers that service). Even though it is part of the CNMs scope of practice to care for babies first month of life, most in hospital practices don’t provide that aspect of care. Out of hospital birth practices, midwives typically do the newborn care (especially the initial newborn exam). How is billing for babies done? Do all insurance companies reimbursement midwives for that service?
Most insurance companies are easy to bill for newborn care. CNMs are recognized with most insurance plans as a covered provider for that service. I have had a couple plans state as denial reason “not covered provider type.” That is part of importance in thorough verification of benefits (VOB). I have trained my staff to ask VERY DETAILED questions to insurance reps if a phone VOB is done. They don’t just ask maternity care coverage with plan. We state, “Does this plan cover a CNM in the home setting for delivery care?” “Does this plan cover an independent Certified Nurse Midwife for newborn care codes 99381 or 99391 in the home setting?” There are some plans that won’t cover a midwife not working under a physician, newborn care in the home setting, or home visit codes for these services like 99349.
Available billing codes for newborn services revolve around screenings and care offered in the first month of life. Our practice offered the vaccinations to families. We gave the Hepatitis B vaccination at the birth center prior to discharge if families desired it. We billed to insurance companies codes 90744 (Hepatitis B Vaccination) and 90471 (immunization injection). Some families wanted eye ointment and vitamin K injection given. Those billing codes were J3490 (erythromycin eye ointment), J3430 (vitamin K injection), and 96372 (IM injection).
Newborn assessments are vital to make sure baby is transitioning well to life outside its mother. Don’t you want to get paid for all your valuable being provided? You have two patients in the postpartum recovery period, make sure you are getting reimbursed for everything you are doing. Initial newborn exam billing code is 99381. Repeat exams 99391. If it is done in the home setting, some insurance companies want you to bill a home visit code and others want the initial newborn screening placed in home setting on claim paperwork. I would usually do 99350 for initial exam and then 99348 for subsequent home visits during postpartum care when insurance plan wanted home visit codes submitted.
Make sure families are aware that coverage level is different for preventative codes like newborn exams versus home visit codes. Many insurance plans don’t have home visit coverage. If coverage present, it may be a co-payment or completely count towards their deductible versus newborn exam codes being covered 100% in the office.
I have had families drive to office for 24hr postpartum exam versus me coming to the home purely because their insurance had no home visit coverage, but would cover a newborn exam 100% in office setting. Families should have a right to know their coverage level and be given options of your services based on what their insurance coverage is actually like.
Newborn hearing screen and newborn metabolic screening (state mandated in many places) are covered 100% by insurance plan. You can refer families out to local resources lab or audiology to complete these screenings or offer them as part of your services. Hearing screen code is V5008 and metabolic screen is 83516. Capillary sample collection billed in conjunction with metabolic screen is 36416.
Another state mandating testing in Michigan is pulse oximetry reading on newborn. That code is 94760. Some insurance plans will recognize all these subset screening codes and others won’t. Unfortunately when most babies are born in the hospital, many of these services are bundled with the hospital facility or nursery charge placed to insurance companies.
Newborn care is very important part of a midwife’s job. Being able to have another revenue stream come into your practice from those services that many people a Pediatrician can only do, really helps your bottom line of business success. I had an average extra $500 from each family’s care come into the practice by performing those newborn exams first month of life.
It was also great to keep the baby’s out of a sick doctor’s office and let mother and baby truly stay home the first few weeks after delivery. Last thing a recovering mother and baby need is getting out into Michigan winter to get all those check ups completed.