Billing update for delivery claims

A gestational age diagnosis code (Z3A.XX) is required for professional and facility claims submitted for delivery services, with a date of service on and after July 1, 2020.

Claims submitted for early elective deliveries (prior to 39+0 weeks) also require an additional diagnosis code(s) to be considered medically necessary. A specific diagnosis code from one of the following series is required:

  • O10
  • O11
  • O12
  • O13
  • O14
  • O15
  • O16
  • O24
  • O30
  • O31
  • O33
  • O35
  • O36
  • O42
  • O43
  • O44
  • O45
  • O60
  • O71
  • R03

If the delivery is spontaneous and occurs prior to the 39th week of gestation, use the appropriate O60 series code.

Published on: June 24, 2020, 03:13 AM ET
Last updated on: June 24, 2020, 03:16 AM ET