Effective July 1, 2023, NC Medicaid has increased the Medicaid rate for Maternal Bundled Payments for pregnancy care. This was a requirement of Senate Bill 20.
“SECTION 4.2.(a) The Department of Health and Human Services, Division of Health Benefits (DHB), shall increase to at least seventy-one percent (71%) of the Medicare rate the Medicaid rate paid for obstetrics maternal bundle payments for pregnancy care.”
Providers can find the applicable rate increases listed on their respective Fee Schedule. Please note that all rates are at 71 % of Medicare or more as legislated and some CPT codes may have been at this rate prior to Senate Bill 20.
| CPT codes affected by this rate increase | |
|---|---|
| 59400 | Routine Obstetrical Care including Antepartum, vaginal delivery (with or without episiotomy and/or forceps) and postpartum care |
| 59409 | Vaginal Delivery Only (with or without episiotomy and/or forceps) |
| 59425 | Antepartum Care Only; 4-6 visits |
| 59426 | Antepartum Care Only; 7 or more visits |
| 59430 | Postpartum Care Only |
| 59514 | Cesarean Delivery Only |
| 59515 | Cesarean Delivery Only including Postpartum Care |
Providers are encouraged to review Clinical Coverage Policy 1E-5, Obstetrical Services for a detailed overview of other language and guidance.
Contact
NCTracks Call Center: 800-688-6696