Arizona Medicaid OB Billing Requirements: Eligibility, Coverage & Documentation Standards

Arizona Medicaid, administered through the Arizona Health Care Cost Containment System (AHCCCS), provides comprehensive obstetric care coverage to eligible members, including prenatal, delivery, and postpartum services. AHCCCS generally supports global obstetric billing when specific clinical and administrative criteria are met, streamlining claims for prenatal through postpartum care. However, when these criteria are not satisfied, itemized (unbundled) billing is required. 

This guide offers a clear roadmap for Arizona Medicaid OB billing, outlining eligibility, coverage rules, documentation standards, and best practices for compliant claims.

AHCCCS Maternity Care Framework for Arizona Medicaid OB Billing

Arizona Medicaid, through AHCCCS, covers the full maternity care continuum. Key aspects of coverage and billing include:

Preconception, Prenatal, and Postpartum Coverage

AHCCCS covers preconception counseling, pregnancy identification, prenatal care, treatment of pregnancy‑related conditions, labor and delivery, and postpartum care.

Compliance with AHCCCS Medical Policy Manual (AMPM)

All maternity services must follow the AHCCCS Medical Policy Manual (AMPM), especially AMPM 410 (Maternity Care Services) and related maternal/child health policies.

Reporting Requirements for Contractors

Contractors (health plans) must report total prenatal visits and the first and last prenatal visit dates on claims, regardless of whether global or itemized billing is used.

Global OB Package vs. Itemized Billing in Arizona

AHCCCS Fee‑for‑Service (FFS) explicitly recognizes a global maternity package when all requirements are met.

Global Obstetric Billing

Global obstetric billing, which covers total OB care, applies only for the plan in effect on the delivery date and only if global guidelines are satisfied, for example, completing five or more prenatal visits while the member is eligible under that plan.

When global criteria are met, a single global code (such as 59400, 59510, 59610, 59618) may be used, depending on the contractor policy, such as Arizona Complete Health’s global maternity package policy.

When Itemized Billing is Required

If global guidelines are not met, due to insufficient visits, plan changes, late entry to care, or split care, services must be billed fee‑for‑service by component, rather than as a global package.

Common Component Codes

Common professional component codes, consistent with national use and Arizona plan policies, include:

• Antepartum only: 59425 (4–6 visits), 59426 (7+ visits), or individual E/M codes when partial packages do not apply.
• Delivery only: 59409 (vaginal), 59514 (cesarean), 59612/59620 (VBAC scenarios).
• Postpartum only: 59430 or E/M codes for postpartum care when not included in global billing.

Professional OB Billing in Arizona (Office/Clinician)

For AHCCCS members, follow these billing patterns while confirming each health plan’s payment policy (Mercy Care, Arizona Complete Health, UHC, Health Choice, etc.).

Eligibility and Health Plan Verification

• Confirm AHCCCS eligibility and the member’s specific health plan for every date of service (DOS).
• Newborns receive separate AHCCCS IDs and must be billed individually; newborn services included on the mother’s claim will be denied.

Prenatal Care Billing

• Track the number of prenatal visits and the dates of the first and last visit for inclusion on claims.
• If global criteria are expected to be met with the same plan and provider group, plan to bill global at delivery; otherwise, bill antepartum by visit or use partial antepartum codes (59425/59426).
• Some plans, such as Arizona Complete Health, require 59425/59426 to be billed one code per visit, per DOS, rather than a single line covering all visits.

Delivery Billing

• Bill delivery-only or global delivery codes on the date of delivery using the appropriate ICD-10 pregnancy/delivery diagnoses.
• Anesthesia for labor/delivery follows ASA coding rules, for example:
  • 01967 – neuraxial labor analgesia for planned vaginal delivery
  • 01968 – add-on for cesarean delivery
  • 01960/01961 – vaginal or cesarean only
• AHCCCS uses time units and base units per Chapter 10 of the FFS manual.

Postpartum Care Billing

• Postpartum services, usually up to 60 days after delivery (or longer if policy allows), are included in global billing; otherwise, bill 59430 or appropriate E/M codes.

Documentation and Compliance Expectations

• Maintain comprehensive prenatal records, including risk assessments (medical, psychosocial, nutritional, educational) using standardized tools like ACOG or MICA forms as encouraged by AHCCCS.
• Document medical necessity for inductions and cesareans; AHCCCS explicitly denies payment for inductions before 39 weeks or cesareans not meeting nationally established criteria.
• Keep clear records of referrals, family planning counseling, and postpartum contraception discussions. Providers must inform members about family planning options and document their willingness to receive services.

Key Components of Arizona Medicaid OB Billing

For clarity, AHCCCS and Arizona Medicaid plans have specific approaches for prenatal, delivery, postpartum, and facility billing, along with plan-specific rules. Below is a component-based overview:

Prenatal Care

• Typical approach: Global package if ≥5 visits and same plan in effect; otherwise use 59425/59426 or E/M per visit.
• Key notes: Always report first and last prenatal DOS and total number of visits on the claim.

Delivery (Professional)

• Typical approach: Use global delivery code (59400, 59510) if criteria met; otherwise delivery-only codes (59409, 59514, etc.).
• Key notes: Anesthesia billed separately with ASA codes (01967, 01968, 01960, 01961).

Postpartum Care

• Typical approach: Included in global when billed; otherwise 59430 or E/M postpartum codes.
• Key notes: Postpartum timeframe usually at least 60 days; check plan/AMPM for extensions.

Facility & Birthing Center

• Typical approach: Hospitals use standard inpatient billing; free-standing birthing centers bill UB-04 Rev 724, Bill Type 84X with facility fee.
• Key notes: Professional services billed separately on CMS-1500.

Plan-Specific Rules

• Typical approach: AHCCCS plans (AZ Complete Health, Mercy Care, UHC, etc.) align with AMPM maternity policies.
• Key notes: Include NOP forms, risk assessment tools, and internal prior authorization/notification requirements.

Maximize Arizona Medicaid OB Billing with BillingFreedom’s Expert Medical Billing Services

At BillingFreedom, we specialize in Arizona Medicaid OB billing, fully understanding AHCCCS eligibility, coverage rules, and documentation standards. Whether it’s global OB packages or itemized billing, we ensure every claim meets plan-specific requirements for Mercy Care, Arizona Complete Health, UHC, and Health Choice. 

Our team carefully tracks prenatal visits, delivery dates, and postpartum care, aligning claims with AMPM 410 and maternal/child health policies to reduce denials and ensure accurate reimbursement.

We also provide guidance on proper coding, documentation, and medical necessity, including inductions, cesareans, and postpartum services. With BillingFreedom, your practice can avoid common billing pitfalls, maintain compliance, and maximize timely payments, all while keeping patient care the priority. Trust us to handle the complexities of AHCCCS OB billing so you can focus on delivering quality care.

For more details about our exceptional OBGYN medical billing services in Arizona, please don't hesitate to contact us via email at info@billingfreedom.com or call us at +1 (855) 415-3472.

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