Free-Standing Birth Center Services

Revised: March 13, 2024

· Overview

· Eligible Providers

· Eligible Members

· Covered 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 if a licensed health professional provides the service. 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 Members

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

Covered Services

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

· Prenatal visits

· Routine lab services

· Ultrasound

· Low-risk labor and delivery

· First postpartum visit

· Newborn care services

· Labor care prior to a hospital transfer

Inpatient Hospital Birth Weight Requirement

MHCP will deny claims that do not contain a valid birth weight. Refer to the Inpatient Hospital Services section of the MHCP Provider Manual for birth weight requirement.

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.

· MHCP will cover an appropriate Evaluation and Management (E/M) visit if the member is transferred to a hospital for emergency delivery.

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

· Home births

· General or regional anesthesia

Billing

· Review Billing Policy Overview for MHCP billing information.

· Bill professional CNM and CPM charges using the MN–ITS 837P , as follows:

· Use CPT code 59400 for the global OB package (pre-natal, vaginal delivery and postpartum care).

· If a member is transferred to the hospital before delivery, bill for all professional services provided to the member in the birth center before transfer.

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

· Type of bill is 0840 through 0848

· Revenue code is 0724

· Use code 59400 for delivery in the birth center, S4005 for transfers to a hospital

· Refer to Laboratory and Pathology Services section of 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 a mother and her newborn. When a mother is enrolled in a managed care organization (MCO) at the time of birth, the newborn will be retroactively enrolled in the same MCO 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)