Prenatal and Postpartum Quality Care
Date: 03/19/24
Managed Health Services (MHS) provides health insurance coverage for Medicaid members enrolled in Hoosier Healthwise, the Healthy Indiana Plan (HIP) and Hoosier Care Connect, as well as MHS’ Marketplace product Ambetter from MHS.
MHS is committed to the provision of a well-designed and well-implemented Quality Program to improve the experience and health outcomes of MHS’ Indiana members. The prenatal and postpartum care (PPC) quality measure evaluates the percentage of live birth deliveries on or between October 8 of the year prior to the measurement year and October 7 of the measurement year. For these women, the measure assesses the following facets of prenatal and postpartum care:
Timeliness of Prenatal Care: percentage of deliveries that received a prenatal care visit in the first trimester, on or before the enrollment start date, or within 42 days of enrollment in the organization.
Postpartum Care: percentage of deliveries that had a postpartum visit on or between 7 and 84 days after delivery.
Primary Care Providers may be eligible to receive bonus payments related to quality performance as part of our Pay for Performance (P4P) initiative. Your MHS Provider Engagement Administrator (PEA) can provide additional details and earning potential specific to your group. Your designated PEA can be located at mhsindiana.com/providers/resources/guides-and-manuals.html.
| Description | Codes* |
|---|---|
| Prenatal Visits | CPT: 99202, 99211-15, 99483 HCPCS: G0463, T1015 |
| Prenatal Bundled Services | CPT: 59400, 59425-26, 59510, 59610, 59618 HCPCS: H1005 |
| Stand Alone Prenatal Visits | CPT: 99500 CAT II: 0500-02F, 0501F, 0502F HCPCS: H1000-04 |
| Cervical Cytology Lab Test | CPT: 88141-43, HCPCS: G0123-24, G0141, G0143, |
| Postpartum Visits CPT: 57170, 58300, 59430, 99501 CPTII: 0503F HCPCS: G0101 ICD-10: Z01.411, Z01.419, Z01.42, Z30.430, Z39.1, Z39.2 | CPT: 57170, HCPCS: G0101 ICD-10: |
| Postpartum Bundled Services | CPT: 59400, 59410, 59510, 59515, 59610, 59614, 59618, 59622 |
| Online Assessments | CPT: 99457 |
| Telephone Visits | CPT: 98966-68, 99441-43 |
*Codes are subject to change
To accurately capture and report data related to these measures, we remind healthcare providers to use the appropriate codes when documenting care.
When utilizing Online Assessment, Telephone Visit, or Prenatal Visit codes, please remember to include a Pregnancy Diagnosis code. This ensures that the care provided is correctly attributed to prenatal and postpartum care.
If you have any questions or require further information on our quality program or coding guidelines, please do not hesitate to reach out. Together, we can continue to provide exceptional care to our members.