Wisconsin Medicaid: Remember state requirements when submitting claims for OB antepartum care
Wisconsin requires only the date of a member’s last visit when submitting an obstetrics antepartum claim for 4 or more encounters. Claims that include a date range covering all visits will be denied.
According to ForwardHealth, “Reimbursement for antepartum care is limited to once per pregnancy, per member, per billing provider.”1
How to submit an antepartum claim
- Complete all antepartum care visits before submitting a claim or claim adjustments
- Submit 1 claim and claim detail covering all antepartum care visits
- Submit a claim through the UnitedHealthcare Provider Portal or electronic data interchange (EDI) or send us a fax:
- Enter the appropriate CPT® codes:
- 59425 – antepartum care only; 4-6 visits
- 59426 – antepartum care only; 7-8 visits
- Enter the allowable modifier: AQ
- Enter “1” for the quantity
- Enter the last encounter date as the date of service. Do not include a span of dates.
- Enter the appropriate CPT® codes:
Resources
For more details, read topic 1251, Submitting Claims or Claim Adjustments for Separate Obstetric Care Components on the ForwardHealth page of Wisconsin.gov.
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1Submitting Claims or Claim Adjustments for Separate Obstetric Care Components, ForwardHealth, wisconsin.gov.
CPT® is a registered trademark of the American Medical Association.
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