Florida Medicaid OB Billing and Coding Guidelines

Florida Medicaid reimburses obstetric care in three separate components:

• Prenatal care (H-codes)
• Delivery services (CPT codes)
• Postpartum care

This guide explains coding, modifiers, visit limits, and payment expectations for accurate OB care billing under Florida Medicaid.

Prenatal Care Coding

• H1001 – Used for the initial prenatal assessment along with the Healthy Start screening.
  • Bill once per pregnancy.
  • Add TG modifier for high-risk cases.
  • Screening must be documented.
• H1000 – Used for follow-up prenatal visits.
  • Bill by date of service with valid OB ICD-10 codes.
  • Visit limits:
    • Up to 9 visits for routine pregnancies.
    • Up to 13 visits for high-risk pregnancies.

Delivery Coding

Use the following CPT codes according to the delivery type:

• 59409 – Vaginal delivery only.
• 59514 – Cesarean delivery only.
• 59612 – Vaginal delivery after a previous cesarean.
• 59618 – Attempted vaginal birth after cesarean (VBAC) delivered by C-section.
• 59410, 59515, 59614, 59622 – Delivery procedures, including postpartum care, corresponding to each delivery type above.

Common Modifiers in OB Billing

• TG – High-risk case (used with H1001).
• TH – Obstetrical service, prenatal or postpartum.
• 59 – Distinct procedural service.
• 25 – Separate evaluation and management (E/M) service performed on the same day.

Visit and Ultrasound Limits by Plan

• Straight Medicaid (Fee-for-Service):
  • 10 routine visits and 14 high-risk visits allowed.
  • 3 ultrasounds covered; a 4th or more requires authorization.
• Aetna, Sunshine, Humana, Simply, UnitedHealthcare, Molina:
  • Follow the same visit limits.
  • A 4th or additional ultrasound requires medical necessity documentation.

Example Billing Scenario

High-Risk Pregnancy Example:

• H1001-TG (initial visit)
• H1000 × 10 (follow-up visits)
• 59409 (delivery)
• 59430 (postpartum care)

Estimated Total Reimbursement: Approximately $1,850–$1,890

Accurate use of Florida Medicaid OB care codes, modifiers, and visit limits is essential for correct claim submission and full reimbursement. Proper documentation and code selection ensure compliance and prevent payment delays for prenatal, delivery, and postpartum services.

Expert Handling of Florida Medicaid OBGYN Billing Services by BillingFreedom

Florida Medicaid’s obstetric billing requires a deep understanding of how prenatal, delivery, and postpartum services are reimbursed. Each stage follows specific guidelines, from using H-codes for prenatal visits to CPT codes for deliveries and applying the correct modifiers for postpartum care. 

BillingFreedom’s OBGYN medical billing services in Florida are highly experienced in managing these technical details, ensuring accurate claim submission, proper code selection, and compliance with Medicaid rules.

Our team understands the complexities of visit limits, ultrasound authorizations, and the distinct billing requirements for high-risk pregnancies. By maintaining precision in codes such as H1001, H1000, and 59409 through 59622, BillingFreedom helps providers reduce denials and achieve timely reimbursements.

With a proven record in OBGYN medical billing, BillingFreedom helps practices navigate Florida Medicaid’s component-based system efficiently, enabling physicians to stay focused on patient care while ensuring accurate financial outcomes.

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

Your financial tranquility is our priority!