Mountain State Medical Policy Bulletin
Section: Miscellaneous
Number: G-1
Topic: Newborn Care & Associated Services
Effective Date: August 1, 2005
Issued Date: August 1, 2005
Date Last Reviewed: 06/2005

General Policy Guidelines

Indications and Limitations of Coverage

Payment may be made for routine in-patient care of a newborn.

If the doctor who performs the delivery also provides routine care for the newborn after delivery, payment may be made for both services.

When reported, payment may be made for attendance at delivery for an at risk neonate to a doctor other than the doctor who performs the delivery.

  • For attendance at a cesarean section or attendance at a vaginal delivery, use code 99436.
  • Payment may be made for one attendance (99436) for each newborn per delivery session (i.e., multiple births).
  • Any specific procedures that are necessary to care for the sick infant(s) should be reported under the appropriate procedure code (e.g., intubation - 31500, resuscitation - 99440).
  • When attendance at delivery (99436) and resuscitation (99440) are reported by the same doctor, the charges should be combined and processed under code 99440. The allowance for the resuscitation includes the allowance for the attendance at the delivery.
  • If a doctor other than the doctor performing the delivery reports both attendance at the delivery and daily medical care of the newborn, payment may be made for both services.
Note: The above guidelines apply to claims reporting a maternity diagnosis (e.g., twin gestation, cesarean section).

Procedure Codes

315009922199222992239923199232
992339923899239994319943399435
9943699440    

Traditional Guidelines

Refer to General Policy Guidelines

FEP Guidelines

Refer to General Policy Guidelines

PPO Guidelines

Refer to General Policy Guidelines

Managed Care POS Guidelines

Refer to General Policy Guidelines

Publications

References

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Glossary




This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Medical policies are designed to supplement the terms of a member's contract. The member's contract defines the benefits available; therefore, medical policies should not be construed as overriding specific contract language. In the event of conflict, the contract shall govern.

Medical policies do not constitute medical advice, nor the practice of medicine. Rather, such policies are intended only to establish general guidelines for coverage and reimbursement under Mountain State Blue Cross Blue Shield plans. Application of a medical policy to determine coverage in an individual instance is not intended and shall not be construed to supercede the professional judgment of a treating provider. In all situations, the treating provider must use his/her professional judgment to provide care he/she believes to be in the best interest of the patient, and the provider and patient remain responsible for all treatment decisions.

Mountain State Blue Cross Blue Shield (MSBCBS) retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of MSBCBS. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.