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Free-Standing Birth Center Services

Revised: 06-13-2016

Overview

MHCP covers low-risk pregnancy and delivery services provided in a licensed, free-standing birth center if the service is covered when provided in a hospital by a licensed health professional. Free-standing birth centers are licensed health care facilities that perform low-risk deliveries following a low-risk pregnancy by a licensed health professional. A low-risk pregnancy is a normal, uncomplicated pregnancy. A free-standing birth center is not a hospital or licensed as part of a hospital. All free-standing birth centers must be accredited by the Commission for the Accreditation of Birth Centers (CABC).The Minnesota Department of Health (MDH) issues licenses for free-standing birth centers.

Eligible Providers

Refer to Provider Requirements for detailed provider policies. MHCP reimburses free-standing birth center services performed by the following licensed providers:

  • • Certified Nurse Midwives (CNM) (must be licensed by the Minnesota Board of Nurses)
  • • Certified traditional midwives (CPM) (must be licensed by the Minnesota Board of Medical Practice
  • • Physicians
  • A licensed, free-standing birth center may only render care or services permitted within the scope of the issued license or accreditation.

    Eligible Recipients

    All MA and MinnesotaCare recipients are eligible to receive free-standing birth center services.

    Covered Services

    Covered professional services include the following (all care must be documented):

  • • Antepartum (before childbirth) visits
  • • Routine lab services
  • • Ultrasounds
  • • Labor and delivery
  • • First postpartum visit
  • • Newborn care services
  • Ultrasounds for Zika Virus

    MHCP will cover ultrasounds for the Zika virus if a positive diagnosis is determined from a blood test.

    Covered facility services include:

  • • Uncomplicated delivery; a single global payment for routine obstetric care that includes:
  • • Antepartum (before childbirth) care
  • • Delivery services
  • • Postpartum care
  • • Ancillary services and items relating to delivery or labor
  • • Recipient transfer to a hospital before delivery
  • Birth Weight Requirement

    Refer to the Inpatient Hospital Services section for birth weight requirements.

    Service Limitations

    The following limitations apply to the services performed at a free-standing birth center:

  • • Surgical procedures must be limited to those normally provided during an uncomplicated birth, including episiotomy and repair.
  • • No general or regional anesthesia may be administered (local anesthesia may be administered at a free-standing birth center when performed within the scope of practice of the health care professional).
  • • Nursery charges are not separately reimbursed.
  • Noncovered Services

    The following are not covered for free-standing birth centers:

  • • Abortion services
  • • Services provided by an unlicensed traditional midwife
  • • Home births including:
  • • Travel time
  • • Facility charge
  • Billing

  • • Refer to Billing for MHCP billing policy
  • • Bill professional CNM & CPM charges on the 837P, as follows:
  • • Use CPT code 59400 for antepartum (before birth), labor and delivery and postpartum care
  • • If a recipient is transferred to the hospital before delivery, professionals may bill an Evaluation and Management (E/M) visit and appropriate prolonged care codes. Only one 99355 may be billed per recipient transfer, up to six units (three hours max)
  • • Bill facility charges on the Outpatient 837I, as follows:
  • • Type of bill is 084x (0840 through 0848)
  • • Revenue code is 0724
  • • Use CPT code 59400 when globally billing facility charges
  • • Use HCPCS code S4005 for transfers
  • • Refer to Laboratory/Pathology Services for laboratory and pathology services policy including MDH Newborn Metabolic Disorder Screening
  • • Refer to Radiology/Diagnostic Services for ultrasound policy
  • For professional services, submit separate claims for a mother and her newborn. When a mother is enrolled in a health plan at the time of birth, the newborn will be retroactively enrolled in the same health plan for the birth month, unless the newborn meets an exclusion (refer to Managed Care Organizations (MCOs) and Prepaid Health Plans (PPHPs), Excluded Recipients section).

    For questions about a claim, contact the MHCP Provider Call Center at 651-431-2700 or 800-366-5411.

    Payment Methodology

    Professional services provided in a free-standing birth center are paid at the lower of billed charges or 100% of the rate paid to a physician performing the same services.

    Facility services provided by a free-standing birth center are paid at the lower of billed charges or 70% of the statewide average hospital payment for an uncomplicated vaginal birth.

    If the recipient is transferred to a hospital before the delivery, facility services are paid at the lower of billed charges or 15% of the statewide average hospital payment for an uncomplicated vaginal birth.

    Legal References

    Minnesota Statutes 256B.0625, subd 54 (Services provided in Birth Centers)
    Minnesota Statutes 147D
    (Traditional Midwives)
    Minnesota Statutes 144.615
    (Birth Centers)

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    Updated: 6/13/16 9:23 AM | Accessibility | Terms/Policy | Contact DHS | Top of Page | Updated: 6/13/16 9:23 AM