Amerigroup-Incentive for Ensuring Moms Receive Timely Postpartum Care

Effective immediately, participating providers can receive additional reimbursement for ensuring that members receive timely postpartum care.

Here’s how our Pay-for-Performance Postpartum Incentive works:

1. Complete a postpartum visit between 21 and 56 days after your Amerigroup member delivers a live infant.

2. Bill using the appropriate delivery code below with the member’s date of delivery. Be careful not to bill using the date of admission or date of discharge.

3. Submit your claim with the CPT Category II, 0503F-code

Incentive amount: $50 for each timely postpartum visit. This incentive will only be reimbursed when the visit occurs within 21-56 days from the date of a live delivery. This amount will be paid in addition to global delivery claims if billed correctly.

Eligible provider: All contracted obstetricians, gynecologists, family physicians, midwives, and family nurse practitioners, certified nurse practitioners and PCPs who complete timely postpartum visit services.

How is the visit reimbursed? For this incentive, Amerigroup will reimburse the CPT Category II code, 0503F, defined as a postpartum care visit. This code will help with Healthcare Effectiveness Data and Information Set (HEDIS) data collection.

What should be included in the postpartum visit?

Documentation between 21 and 56 days following a live birth must include one of the following:

  • Notation of postpartum care (i.e., PPV, six-week checkup or a preprinted Postpartum Care form)
  • Pelvic exam (Pap test counts as pelvic exam)
  • Evaluation of weight, blood pressure, breasts and abdomen must have all four components (a notation of “Breastfeeding” is acceptable for breast evaluation)
  • Family planning options
  • STI education to include screenings and prevention
  • Assessment for Postpartum Depression

Amerigroup is pleased to reward physicians for efforts in making sure new mothers get the care they need on time. Please contact your local Provider Relations representative if you have any questions about this program.