Free-Standing Birth Center Services

Revised: June 15, 2026

· Overview

· Eligible Providers

· Eligible Members

· Covered Services

· Noncovered Services

· Telehealth Services

· Noncovered Services

· Billing

· Legal References

Overview

Minnesota Health Care Programs (MHCP) covers low-risk pregnancy and low-risk delivery services provided in a licensed free-standing birth center, provided the service is delivered by a licensed health professional. A free-standing birth center is defined as a facility that 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) licenses 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 Members

All Medical Assistance (MA) and MinnesotaCare members are eligible.

Covered Services

Covered services include the following (providers must document all care):

· Prenatal visits

· Routine lab services

· Ultrasound

· Low-risk labor and delivery

· Postpartum visits

· Newborn care services

· Labor care prior to a hospital transfer

· All professional services associated with pregnancy, postpartum and newborn care

· Home visits

Note: Services performed at a free-standing birth center that are within the eligible provider’s scope of practice but not included in covered services may be billed under a different enrollment record (for example, a medical service group). These provider records may be consolidated for billing purposes. Refer to Consolidated Providers under Enrollment with Minnesota Health Care Programs in the HCP Provider Manual for more details.

Coverage Limitations

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

· MHCP only covers surgical procedures normally provided during an uncomplicated birth, including episiotomy and repair.

· MHCP only covers local anesthesia when administered within the scope of practice of the health care professional.

· MHCP does not reimburse nursery charges separately.

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

Telehealth Services

Telehealth services are covered for MHCP members. Providers must submit a completed and signed Telehealth Provider Assurance Statement (DHS-6806) (PDF) to the Minnesota Department of Human Services to bill for telehealth services. Review Telehealth Services in the MHCP Provider Manual for more information.

Noncovered Services

· Abortion services

· Services provided by an unlicensed traditional midwife

· General or regional anesthesia

Billing

· Review Billing Policy Overview for MHCP billing information.

· Bill professional charges using the MN–ITS 837P. Refer to Obstetric Services in Billing under Obstetric Services in the MHCP Provider Manual for billing processes.

· If a member is transferred to the hospital before delivery, bill code S4005 for professional services rendered.

· Bill facility charges using the MN–ITS 837I Outpatient Services, as follows:

· For the birthing person:

· Type of bill is 0840 through 0848

· Revenue code is 0724

· Use code 59400 for delivery in the birth center

· This charge for the facility includes the cost of the newborn screening card.

· Do not bill the newborn screening card fee (S3620) separately

· Use code S4005 for transfers to a hospital

· This charge for the facility does not include the cost of the newborn screening card.

· If the newborn is born in a hospital setting but the screening was performed at home by the birth center following discharge from the hospital, bill the newborn screening card fee (S3620).

· Professional fees associated with the newborn screening service may be billed on a professional claim.

· For the newborn:

· Type of bill is 0840 through 0848

· Revenue code is 0724

· Use code 99463 for delivery in the birth center

· Refer to Laboratory and Pathology Services in the MHCP Provider Manual for laboratory and pathology services policy.

· Go to the Minnesota Department of Health’s Newborn Screening Program webpage for screening information.

· Refer to Radiology/Diagnostic Services section of the MHCP Provider Manual for ultrasound policy.

For professional services, submit separate claims for the birthing person and their newborn. When a birthing person is enrolled in managed care organization (MCO) or fee-for-service coverage at the time of birth, the newborn will be retroactively enrolled in the same MCO or fee-for-service coverage for the birth month, unless the newborn meets an exclusion. Refer to Excluded Members section of the Managed Care Organizations (MCOs) manual for more information.

Legal References

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