Maternity Initiatives FAQs

Maternity Initiatives FAQs

Which plans require us to follow the Birth Outcomes Initiatives filing guidelines? The BOI filing requirements apply to all BlueCross BlueShield of South Carolina and BlueChoice HealthPlan plans as well as out-of-state members (BlueCard®).

Should I submit the American Congress of Obstetricians and Gynecologists (ACOG) Patient Safety Checklist when I file a claim? Complete the checklist and keep it in the patient’s chart. We may request a copy of this for verification.

Do you give additional reimbursement for filing the UA modifier? Medicaid makes an additional payment for this modifier. We do not give additional reimbursement for filing the UA modifier. We pay for procedures based on each provider’s contracted rate or fee schedule.

Is the UA modifier required for code 59514? We do not require the UA modifier for code 59514. File whichever modifier is appropriate for this code, based on the guidelines and what is medically appropriate.

If a surgical assistant is involved, do I file the UA modifier in addition to the assistant modifier? Yes. If an assistant surgeon is providing services, you should file the UA modifier in conjunction with the assistant surgeon modifier (80). You should append modifiers to services as applicable in addition to the BOI modifier based on the BOI filing guidelines.

Which plans participate in the SBIRT program? All South Carolina BlueCross and BlueChoice® plans participate in the Screening, Brief Intervention and Referral Treatment (SBIRT) program with the exception of:

  • Federal Employees Program (FEP)
  • South Carolina Health Insurance Pool (SCHIP)
  • Plans that do not have maternity benefits
  • Out-of-state members (BlueCard)  

Effective Oct. 1, 2014, the State Health Plan is also participating with the SBIRT program. 

I’ve provided services to a member whose plan is not participating in the SBIRT program. Should I bill the member? You should not hold members whose plans are not participating liable if you have provided services.

Should I bill for a referral to treatment if the patient refuses the intervention? Should I bill for the referral to treatment if the patient screening does not yield a positive result? You can bill for the intervention (H0004) if an intervention has taken place and you made or attempted to make a referral appointment while the patient is in the office. If the result of the screening is negative, do not provide a referral and intervention, or bill for them.

How will BlueChoice determine if I made an actual referral to treatment? If the member’s responses result in a positive SBIRT screening, an intervention and referral should take place. The screening tool includes fields to report the organization or provider to which you referred the member. Be sure to fill out the tool completely. Once Maternity Management receives the completed screening tool, we will assign a case manager to review it. The case manager will follow up with the provider or member as needed and provide additional referral resources to the member if necessary. You should also bill the referral and intervention using the H0004 procedure code.

If the screening is negative, do I need to submit the referral form? No. You should only submit the SBIRT form if there is a positive result, which requires a referral to treatment and intervention.

Do I need to file the U1 modifier for H0002 or H0004 for SBIRT services? No. The South Carolina Department of Health and Human Services (SCDHHS) required the U1 modifier previously. It is no longer required as of July 1, 2014, and we do not require this modifier, either.

Do you accept the HD modifier when filed with H0004? This is how we file for Medicaid. We do accept the HD modifier when filed with H0004, however, it is only required for the H0002 when the screening results are positive and the member requires a referral to treatment.

Are we required to file claims for the screening or intervention with evaluation and management (E/M) codes for the same date of service as well? We file maternity charges globally. This means there would not be an associated office visit to file at the time of the screening or intervention. No, you are not required to file the E/M codes with SBIRT services. We pay these services separately from maternity care.

Is there an age restriction for SBIRT? There is not an age restriction for SBIRT. It is important to note that if a member’s plan does not provide maternity coverage for dependents, we will not cover SBIRT for the dependent. Please verify eligibility and benefits prior to rendering services.

Can family practices participate with SBIRT? At this time, the SBIRT program is specifically applicable to obstetricians and gynecological practices. 

What are the reimbursement requirements for participation in the Centering Pregnancy program? What reimbursements will participating providers receive? Approved practices under contract with the Centering® Healthcare Institute (CHI) are eligible for program participation. Centering Pregnancy is a program of CHI, an independent company that provides wellness education information on behalf of BlueCross and BlueChoice HealthPlan of South Carolina.

Participating providers will receive reimbursement for providing these services:

  • 99078 with TH modifier - reimbursement is $30.00 per visit, up to 10 visits total 
  • 0502F - reimbursement is $175.00 as a one-time retention incentive on or after the fifth visit 

These services pay separately from global maternity benefits. You should file the appropriate pregnancy diagnosis code. 

Are the procedure codes used for Centering Pregnancy similar to those used for Medicaid services? Yes, the same procedure codes Medicaid uses also apply for Centering Pregnancy.

How do I become a Centering Pregnancy program provider? If you are interested in the Centering Pregnancy program, please visit the CHI website at www.centeringhealthcare.org. (This link leads to a third party site. That organization is solely responsible for the contents and privacy policies on its site.) 

Once you have membership with CHI and are also in the process of achieving Site Approval Status, you must complete the Centering Pregnancy Application Form to apply for participation with BlueCross and BlueChoice. 

The Centering Healthcare Institute is a separate company that provides wellness education on behalf of BlueChoice HealthPlan of South Carolina. 

Which plans participate in the Centering Pregnancy program? All South Carolina BlueCross and BlueChoice plans participate in the SBIRT program with the exception of:

  • Federal Employees Program (FEP)
  • South Carolina Health Insurance Pool (SCHIP)
  • Plans that do not have maternity benefits
  • Out-of-state members (BlueCard)

Effective October 1, 2014, the State Health Plan is also participating with the Centering Pregnancy program.

I’ve provided services to a member whose plan is not participating in the Centering Pregnancy program. Should I bill the member? You should not hold members whose plans are not participating liable if you have provided services.

Should we bill the Centering Pregnancy service under the patient’s global maternity or as an encounter? You should bill Centering Pregnancy visits separately from global maternity.

Will I need to give a 30-40 minute individual assessment with each patient in the Centering Pregnancy group? No. The 30-40 minutes is the estimated time allotted for individual assessments for all of the Centering Pregnancy participants during each session. 

Can midwives conduct Centering Pregnancy visits if the Centering Healthcare Institute contracts and approves the practice? Will you cover and reimburse the visits the same as if a physician conducts the visits? Certified nurse midwives (CNM) as well as physicians and nurse practitioners (NP) can conduct Centering Pregnancy visits. 

I have a patient who has been participating in Centering Pregnancy prior to the July 1, 2014 start date. Do I count visits prior to July 1 and bill the retention incentive (0502F) for the fifth visit? If you have a patient who began participation in the Centering Pregnancy program prior to July 1and is continuing to participate, you can bill for the retention incentive. File both 0502F and 99078. Complete the Centering Pregnancy Verification form available at www.BlueChoiceSC.com. This form alerts us that a member has had Centering Pregnancy visits prior to our implementation of this program. It will ensure we process claims for the retention incentive.

Are we required to file claims for Centering Pregnancy session with E/M codes for the same date of service as well? We file maternity charges globally. This means there would not be an associated office visit to file at the time of the screening or intervention. No, you are not required to file the E/M codes with Centering Pregnancy visits. We pay these services separately from maternity care.

Is there an age restriction for Centering Pregnancy? There is not an age restriction for Centering Pregnancy. It is important to note that if a member’s plan does not provide maternity coverage for dependents, we will not cover Centering Pregnancy services for the dependent. Please verify eligibility and benefits prior to rendering services.

Can family practices participate with Centering Pregnancy? Centering Pregnancy is specifically applicable to obstetricians and gynecological practices that are approved or under contract with the CHI. 

Where can I find additional information about your maternity initiatives? Information about our maternity initiatives is available on our website, www.BlueChoiceSC.com

How does the Moms Support Program work? If an expectant mother has been referred to Companion Benefit Alternatives (CBA) for services, the member can be enrolled in the Moms Support Program. CBA is a separate company that administers mental health and substance abuse benefits on behalf of BlueCross and BlueChoice. CBA designed this program to help expectant and new mothers who may be experiencing depression or anxiety. The program provides guidance, support, assessment and case management to mothers.

How can I be certain the OB/GYN Report Card gets to the appropriate person in my practice? You can contact your provider advocate and give him or her the information of the person who should receive the report card. You can also contact Provider Education by emailing provider.education@bcbssc.com or calling 803-264-4730.

BlueCross® BlueShield® of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.