Medical Mutual
OHTransition: Services follow the date each service is rendered, not the claim billing date
RP-202701, created and initially effective 01/01/2027, reimburses maternity care by the separately reported component, including antepartum care, labor management, delivery, and postpartum care. Antepartum care must be reported with the appropriate E/M code and modifier TH. 0500F is billed on the initial visit with that E/M code, modifier TH, and a pregnancy-related ICD-10 diagnosis, and is not separately reimbursable. Maternity care codes are not eligible for dates of service on or after January 1, 2027. Labor management may be reported once per calendar date and is not separately reimbursable for a scheduled or planned cesarean when labor does not occur. Multiple-gestation vaginal delivery is one appropriate vaginal delivery code per fetus; only one cesarean delivery code is eligible. Immediate maternal postpartum care on the delivery date is included in delivery care. The policy names Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company.
- Published
- 2027-01-01
- Transition starts
- Services follow the date each service is rendered, not the claim billing date
- Billing starts
- January 1, 2027
- Evidence checked
- 2026-10-08
Billing notes and scope
- Codes affected
- Not published
- Modifiers
- Not published
- Global allowed through
- Not published
- Applies by
- Not published
- Product
- Not published
- Source excerpt
- Not published
Scope: Commercial and Marketplace (Fully-Insured and Self-Funded), and Medicare Advantage. Medical Mutual of Ohio, Medical Mutual Services, LLC except Mutual Health Services, Medical Health Insuring Corporation of Ohio, and MedMutual Life Insurance Company
Transition: applicable to the date each service is rendered, not the billing date for the service.
Global billing: Maternity care codes are not eligible for reimbursement for dates of service on or after January 1, 2027.
Mutual Health Services is a separate commercial self-funded reading of this policy.