Payment Parity for Obstetric Services
As our nation faces a persistent and unacceptable maternal mortality crisis, it is essential that federal and state health care policies be designed to improve access to maternity care and invest in maternal health. State Medicaid agencies that use the global obstetric codes have an opportunity to prioritize maternal health by updating their payment rates to match the rates provided under Medicare.
Medicaid Payment for Obstetric Care
Medicaid financed 43% of all U.S. births in 2018, including 50% of births in rural areas, 60% of births to Latina women, and 66% of births to Black women. As a primary payer of obstetric services, the Medicaid program has a critical role to play in improving the health of our nation’s mothers.
Most state Medicaid agencies require physicians to bill obstetric services using one global obstetric code. The global code encompasses patient care delivered throughout the prenatal, labor and delivery, and postpartum periods. Similar global codes exist for vaginal delivery, cesarean delivery, and vaginal birth after cesarean (VBAC).
Medicaid payment for the global obstetric code is notoriously low. Inadequate payment may result in access challenges for Medicaid beneficiaries. Evidence suggests that low payment rates can lead to physicians choosing not to participate in the Medicaid program as well as to the closure of obstetric units and hospitals.
Hover over the interactive map to see how your state Medicaid payment for CPT code 59400 compares to payments in other states
Opportunity for Advocacy
As a direct result of ACOG advocacy, the Centers for Medicare and Medicaid Services (CMS) updated the relative-value units (RVUs) for the Evaluation and Management (E/M) office visits under Medicare and applied those increased RVUs to the global obstetric codes beginning January 1, 2021.
ACOG is concerned that by failing to match the 2021 Medicare Physician Fee Schedule updates to the global obstetric codes, state Medicaid agencies will continue to offer increasingly insufficient payment rates. State Medicaid agencies that use the global obstetric codes have an opportunity to prioritize maternal health by updating their payment rates to match the new rates provided under Medicare.
To learn more about obstetric payment under Medicare and Medicaid, and to hear more information about how to engage in this advocacy for your practice and your patients, watch the on-demand webinar, Investing in Maternal Health: Advocating for Payment Parity for Obstetric Services, below.
To learn how to advocate for increased payment rates for the global obstetric codes in your state Medicaid program, reach out to your Legislative Chair or email [email protected].