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I am looking for guidance on when and if a maternity digital health platform can bill for RPM/telehealth separately or is this part of the global billing period?
What type of maternity global services would be provided to a pregnant patient via telehealth? Are they services that should be covered as part of the global maternity package? I don't see that any of the maternity CPT codes are eligible for coverage as telehealth services according to Encoder Pro. Also, what type of RPM services are you providing to these patients and again are these services that are potentially included in the global maternity package?
They would be looking to bill any of the following codes..
99453-4, 99457-8, 99091, 99473-4, 98975-77, 98980-81, 99421-3, 98970-2, G2061-3, G2012, G2010, 98960-62, 59400, 59510, 59610, 59618, 99441-3, 98996-8, 99421-3, 96127, 96160-1, 96136, 96138, 96146, 96130, 99452, 99495-6
What is the number listed after the hyphen, is it a number of units or a modifier, some of the numbers are single digit so I'm thinking they aren't modifiers, but I want to make certain I understand what is being proposed as billable for RPM and/or telehealth for maternity care.
I will tell you that your OB codes 59400, 59510, 59610, 59618 are not eligible for telehealth billing as these are global maternity codes that include the delivery, which obviously cannot be performed via telehealth.
With the rest of your codes, it feels like your providers are trying to bill for services that are bundled into the global maternity package and your providers should not be billing for every little interaction had with a patient while they are pregnant.
I would be incredibly careful about how you bill for services that should be included in the global maternity package which includes "Antepartum or prenatal care includes the initial and subsequent histories, physical examinations, recording of weight, blood pressures, fetal heart tones, and routine chemical urinalysis. It includes monthly visits up to 28 weeks gestation, biweekly visits to 36 weeks gestation, and weekly visits until delivery. Postpartum care includes hospital and office visits following delivery."
I'm not saying don't bill for the services that aren't included in the global maternity package, I'm just cautioning you that these codes send up a red flag for me as an auditor for an insurance company because this looks a lot like routine maternity care that should be included in the global package.
The hyphens are through codes so like 99457-99458. If the mother ended up with gestational diabetes or another condition during the pregnancy could they bill any of these codes outside of the global period. They don't currently bill these codes now separately. I am working with a startup maternity health telehealth company who were looking into these codes.
So will the regular OB/GYN then bill insurance for your services on behalf of the patient. I don't understand why there are going to be separately billed charges for services that should be included in the maternal global package. If I was the patient, I would be upset at the additional fees involved in this scenario.