The Washington Healthcare Authority (HCA) has identified a long-standing compliance issue in which OB/prenatal providers (all provider types – licensed midwives, certified nurse midwives, family physicians, OB/GYNs, maternal fetal medicine specialists) are not reporting the 0500F code when they initiate prenatal care with a Medicaid/AH client.
This is the language from the Physician-related/professional services Billing Guide – on pg. 220.
Use HCPCS code 0500F along with the appropriate diagnosis code6 on the first prenatal visit. HCA is tracking the date a client begins receiving obstetrical care (date the OB record is initiated). Note this date by entering HCPCS code 0500F with the appropriate ICD diagnosis codes Z33.1, Z34.00, Z34.80, or Z34.90 on the claim.
HCA contracted providers must comply with this requirement and report the 0500F code when they initiate prenatal care and/or the first prenatal visit. The HCA does not want providers to be reporting the 0500F code later in pregnancy or even post-delivery when they submit the global codes.
Please note that the HCA collects this code for quality measurement, tracking, and care coordination.
Thank you for your attention to this matter.
Please send your questions to [email protected].
