5101:3-4-08.1 Payment for prenatal visits.

(A) Paragraph (D)(1)(c) of rule 5101:3-4-08 of the Administrative Code specifies that providers billing for an antepartum/prenatal visit must bill the code for an evaluation and management office visit to receive reimbursement for a prenatal visit. Providers must choose the office visit code appropriate for the visit documented in the patient's record and modify the code by the "TH" modifier to signify that the visit was for prenatal services.

(B) When the "TH" modifier is billed with an office visit code, the following reimbursement will be made effective for dates of service on and after July 1, 2008:

Office Visit Type Codes Medicaid Maximum

new patient 99201 to and including 99202 $ 49.85

new patient 99203 see rule 5101:3-1-60 of the Administrative Code

new patient 99204 see rule 5101:3-1-60 of the Administrative Code

new patient 99205 see rule 5101:3-1-60 of the Administrative Code

established patient 99211 $ 19.73

established patient 99212 to and including 99213 $ 49.85

established patient 99214 see rule 5101:3-1-60 of the Administrative Code

established patient 99215 see rule 5101:3-1-60 of the Administrative Code

(C) Providers must follow the instructions for selecting the level of evaluation and management service specified in the "CPT" manual. "CPT" as used in this rule is defined in rule 5101:3-1-19.3 of the Administrative Code.

Effective: 07/01/2008
R.C. 119.032 review dates: 09/25/2007 and 07/01/2013
Promulgated Under: 119.03
Statutory Authority: 5111.02
Rule Amplifies: 5111.01 , 5111.02 , 5111.021
Prior Effective Dates: 10/1/03