• Emily Pasternak

Global Vs. Individual Billing

Global billing for contracted midwives with "carve outs" can result in higher payment for services from major insurance companies like Premera, Cigna, EBMS, etc. However, if your patients have Medicaid as a secondary or subsequent payer, billing individually for some services will guarantee your services are covered. For instance-

59400 (Global Maternity Services) is covered my Medicaid as a secondary code when the patient has other primary health insurance. 59425-59426 (Global Prenatal Care) is not covered under any circumstance. Neither are global VBAC codes.

In these cases, the primary health insurance may cover, fully or partially pay for the maternity service but when the patient has a high deductible or coinsurance plan, Medicaid will not pick up the remaining balance unless it is covered on their fee schedule (link attached). If in doubt, contact your biller!

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