Provider Alert! Postpartum Care Visit Update for CHIP Perinate
Date: September 13, 2021
Attention: Obstetric Care Providers
Effective Date: December 1, 2021
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: Texas Children’s Health Plan will align with Texas Medicaid Providers Procedure Manual (TMPPM) for CPT Code 59430. Effective December 1, 2021 postpartum visit code 59430 is only allowed once per pregnancy for STAR, STAR Kids, and CHIP programs. CHIP Perinate is allowed two postpartum visits.
How this impacts providers: Providers must bill CPT Code 59430 one time and use an E/M code 99211-99215 and a diagnosis restriction of postpartum related ICD- 10 Codes Z39.0, Z39.1, and Z39.2 for the additional postpartum visits.
Next steps for providers: Providers should share this communication with their staff.
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
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