Postpartum Coding

Alaska Medicaid

Notice

Medicaid requires all prenatal, delivery, postpartum and newborn care be billed individually, by the visit UNLESS the patient has other insurance. Patients with Medicaid must call the medicaid office to update their coverage from Prenatal to Postpartum effective immediately with the date of delivery. Prenatal coverage expires on the last day of the month of their reported EDD (Estimated Due Date). Postpartum coverage will be extended 6-8 weeks post delivery for income eligible mothers and families. 

In the event a patient has both private and medicaid insurance coverage, the private insurance is ALWAYS billed first. You can submit a global claim to the primary insurance if allowed and then bill to medicaid secondary. See the most current list of covered primary and secondary codes by visiting the Alaska Medicaid provider website and look-up your provider type fee schedule for the current reimbursement period. Any code not listed on this fee schedule will not be reimbursed by medicaid regardless of the primary insurance coverage. Codes requiring other insurance to pay as primary will note *TPL Required* (Third Party Liability). 

Medicaid fee schedules and covered codes lists are updated every year on July 1st and December 31st. 

Postpartum Care

Common ICD-10 Codes

Z39.1 - Encounter for Care of Lactating Mother

Z39.2 - Encounter for Routine Postpartum Care

For more detailed or additional ICD-10 diagnoses coding, please reference any AMA certified coding software or look-up tools and manuals. Please, do NOT use google or other internet search engines for coding. 

Medications including RhoGam can be found in medications/labs/devices.

Established Patient

99211 - LEVEL 1 Established Patient, Office or other Outpatient Visit, Minimal

99212 - LEVEL 2 Established Patient, Office or other Outpatient Visit, Problem Focused

99213 - LEVEL 3 Established Patient, Office or other Outpatient Visit, Expanded Problem Focused

99214 - LEVEL 4 Established Patient, Office or other Outpatient Visit, Detailed

99215 - LEVEL 5 Established Patient, Office or other Outpatient Visit, Comprehensive

99347 - LEVEL 1 Established Patient, Home Visit, Problem Focused

99348 - LEVEL 2 Established Patient, Home Visit, Straightforward

99349 - LEVEL 3 Established Patient, Home Visit, Detailed

99350 - LEVEL 4 Established Patient, Home Visit, Comprehensive - Not Reimbursed by medicaid for CDMs or CPMs 

New Patient 

99201 - LEVEL 1 New Patient, Office or other Outpatient Visit, Problem Focused

99202 - LEVEL 2 New Patient, Office or other Outpatient Visit, Expanded Problem Focused

99203 - LEVEL 3 New Patient, Office or other Outpatient Visit, Detailed

99204 - LEVEL 4 New Patient, Office or other Outpatient Visit, Comprehensive

99205 - LEVEL 5 New Patient, Office or other Outpatient Visit, Complex

99341 - LEVEL 1 New Patient, Home Visit, Problem Focused

99342 - LEVEL 2 New Patient, Home Visit, Expended Problem Focused

99343 - LEVEL 3 New Patient, Home Visit, Detailed

99344 - LEVEL 4 New Patient, Home Visit, Comprehensive

99345 - LEVEL 5 New Patient, Home Visit, Complex - Not Reimbursed by medicaid for CDMs or CPMs 

Global - Only one global code allowed per pregnancy, including postpartum period. Global ppostpartum care is billed using the last date of service only, with primary + any supplemental diagnoses codes. Initial, new patient intake visit is included in global care.

59430 - Postpartum Care Only