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Upcoming Changes for Licensed Midwives

October 25, 2016

Effective retroactively for dates of service on or after July 1, 2015, licensed midwives (LMs) are authorized to enroll independently as Medi-Cal providers and perform obstetrical services without supervision of a licensed physician or surgeon pursuant to California Code of Regulations (CCR), Title 16, Sections 1379.19, 1379.20, 1379.22 and 1379.30.

The Department of Health Care Services (DHCS) is in the process of making system changes to accept and process claims submitted by LMs for obstetrical services rendered, excluding Comprehensive Perinatal Services Program services where LMs can only be employed as contract service providers.

DHCS will provide an update as to when providers can start submitting their claims, including the implementation date of the system changes in a future Medi-Cal update.

The procedures and patient care services listed below are approved for reimbursement to LMs effective for dates of service on or after July 1, 2015. In compliance with the Health Insurance Portability and Accountability Act (HIPAA), DHCS has authorized and approved the use of modifier U9 as the exclusive modifier to identify services rendered by a LM. The following CPT-4 and HCPCS codes may be submitted for reimbursement by a LM when billed with modifier U9.


CPT-4 Code
Definition
31500 Intubation, endotracheal, emergency procedure
51701 Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)
59300 Episiotomy or vaginal repair, by other than attending
59400 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care
59409 Vaginal delivery only (with or without episiotomy and/or forceps)
59410      including postpartum care
59425 Antepartum care only; 4 – 6 visits
59426      7 or more visits
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour
96361      each additional hour
99070 Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered.
99460 Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant
99461 Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center
99462 Subsequent hospital care, per day, for evaluation and management of normal newborn
99463 Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date
99464 Attendance at delivery (when requested by the delivering physician or other qualified health care professional) and initial stabilization of newborn
99465 Delivery/birthing room resuscitation, provision of positive pressure ventilation and/or chest compressions in the presence of acute inadequate ventilation and/or cardiac output
   
HCPCS Code Definition
A4261 Cervical cap for contraceptive use
A4266 Diaphragm for contraceptive use
H1000 Prenatal care, at-risk assessment

LMs who want to enroll as individual billing Medi-Cal providers must complete and submit a Medi-Cal Provider Application (DHCS 6204, Rev 1/13), a Medi-Cal Disclosure Statement (DHCS 6207, rev 2/15) and a Medi-Cal Provider Agreement (DHCS 6208 rev 6/10). LMs who wish to enroll as a rendering provider to an enrolled group must complete and submit a Medi-Cal Rendering Provider Application/Disclosure Statement/Agreement for Physician/Allied/Dental Providers (DHCS 6216, rev 2/15) and a Medi-Cal Rendering Provider/Group Affiliation/Disaffiliation Form (DHCS 4029, rev 8/16). If the group being joined does not already have the LM provider type, the group must submit a Medi-Cal Supplemental Changes form (DHCS 6209, rev 12/14) to report that change.

An approved application is effective retroactive to the date DHCS received the application. Once the application is approved, the LM will be able to bill for Medi-Cal covered services performed on or after the enrollment date.

Providers are encouraged to subscribe to the Medi-Cal Subscription Service (MCSS) to receive notifications. Providers may sign up for MCSS by completing the MCSS Subscriber Form.