First Trimester Incentive Pay
Billing Reminder
Peach State Health Plan would like to remind providers that the Georgia Department of Community Health Medicaid
division provides an incentive pay if the physician begins routine antepartum care in the first trimester of pregnancy
(on or before 13 weeks gestation) and continues to provide normal prenatal care through the entire antepartum,
delivery and postpartum period. The National Committee for Quality Assurance (NCQA) HEDIS measurement
requires that women have a postpartum care visit 21 to 56 days after giving birth.
When providers are submitting pregnancy codes with modifier 22, they are stating the entire antepartum,
delivery and postpartum period were performed.
Please note the following:
•
Providers should be submitting CPT 99211 code with modifier 22 at the time the postpartum care service is
rendered in the office.
•
Providers are required to perform the entire service to include the antepartum, delivery and postpartum
period.
•
Providers can submit a claim for the delivery at the time of delivery without modifier 22 and receive the OB
Global Payment Reimbursement.
•
The postpartum service has not been performed at the time of delivery; therefore billing using POS 21
(Inpatient) or 25 (Birthing Center) is occurring prior to the completion of the postpartum period and does not
qualify for the First Trimester Incentive Pay.
How should providers bill for the incentive?
Peach State Health Plan’s goal is to increase the postpartum compliance rates in accordance to with the HEDIS®
guidelines and the Department of Community Health (DCH) requirements of performing the postpartum visit within
21-56 days after delivery.
CPT Code:
Diagnosis Code
99211-22
Postpartum care and examination (Z39.1 – Z39.2)
Date of Service:
Place of Service:
Date of the postpartum care service
11 (physician’s office)
Information regarding First Trimester Incentive Pay can be found in the Provider Services Manual located on the
MMIS website at www.mmis.georgia.gov. Please contact your Provider Relations Representative, or Provider
Services, at 1-866-874-0633 if you have questions regarding the notice.
1-866-874-0633
TDD/TTY 1-800-255-0056
PS_OBINCE_010714F
PSHP.com