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

Unlike some other states, Maryland Medicaid does not cover global OB packages. Providers must bill prenatal visits, delivery, and postpartum care separately using the appropriate E/M and delivery-only CPT codes, including Maryland-specific risk and enhanced maternity codes. Following these billing requirements carefully helps practices maximize reimbursement, reduce claim denials, and stay fully compliant with state Medicaid rules.

Maryland Medicaid OB Coverage & Maternity Care

Maryland Medicaid MCOs are required to provide medically necessary prenatal, perinatal, and postpartum care, including access to high-risk specialty services when needed.

Extended Postpartum Coverage

Postpartum care is covered for up to 12 months after the end of pregnancy, allowing providers to bill E/M services throughout the full year when medically necessary.

Expanded Eligibility

Under the Healthy Babies Equity Act, coverage has been expanded to include additional pregnant and postpartum individuals regardless of immigration status through a CHIP-based program, ensuring more individuals have access to essential maternity care.

No Global Maternity Packages in Maryland Medicaid

Maryland Medicaid OB/GYN guidance clearly states that global maternity services are not reimbursed.

• Physicians are not paid for global OB services.
• Deliveries must be billed separately from prenatal care. Codes such as 59400, 59425, 59426, 59510, and 59610 cannot be used for global payment.
• Each prenatal visit must be billed individually using the appropriate E/M code and linked to the correct ICD‑10 pregnancy diagnosis to ensure accurate claims and compliance.

Prenatal Billing and Enriched Maternity Services Under Maryland Medicaid OB Billing

Proper prenatal billing ensures accurate reimbursement and compliance with Maryland Medicaid requirements, including risk assessment and enriched maternity services.

Prenatal Visits

• Use standard office/outpatient E/M codes (99202–99215) with the appropriate pregnancy ICD‑10 codes for each prenatal visit. Global antepartum bundles are not used.
• Complete the Maryland Prenatal Risk Assessment (MPRA, form MDH 4850) at the first prenatal visit.
• MPRA must be faxed to the local health department and used to create a plan of care.
• Local health departments and MCOs use MPRA data to identify high-risk pregnancies and link members to care coordination and support services.

Enriched Maternity Codes

• Maryland Medicaid reimburses additional fees for enriched maternity services when certain intervention codes (W7000, W7010, W7020, W7021, W7022) are provided, often related to education, psychosocial support, or enhanced case management.
• Alcohol and substance-use screening/brief intervention can be billed with SBIRT codes (H0049/H0050 or state-defined SBIRT codes) and must be documented separately from enriched maternity counseling.
• Group prenatal care models, such as CenteringPregnancy, can bill 99078 for group education.
  • Paid at $50 per participant per visit for up to ten sessions.
  • This is in addition to individual prenatal visit codes.

Intrapartum and Postpartum Coding Under Maryland Medicaid OB Billing

Proper intrapartum and postpartum coding ensures accurate billing for deliveries and postpartum services under Maryland Medicaid.

Delivery (Professional)

• Deliveries are billed separately from prenatal care. Global codes such as 59400, 59510, 59610, etc., are not used for bundled payment.
• Physicians bill intrapartum care using delivery-only CPT codes (59409, 59514, 59612, 59620, 59614) with the appropriate place of service (e.g., 12 or 25) on the CMS‑1500.
• For supplies related to vaginal delivery in certain settings, providers should use the unlisted maternity code 59899.

Postpartum

• Use 59430 for postpartum-only care, including all visits during the postpartum period that are not part of a global package.
• With 12-month postpartum coverage, additional medically necessary postpartum services beyond the classic 6-week window are billed using E/M codes (99211–99215, etc.), with the appropriate postpartum or chronic-condition diagnoses.

MCO-Specific Maternity Requirements

Maryland Medicaid MCOs implement state rules while adding their own processes for prenatal care and enhanced maternity services.

Requirements Across MCOs

• Maryland HealthChoice MCOs (e.g., Maryland Physicians Care, Priority Partners, Amerigroup, Aetna Better Health) follow state rules but have their own processes for prenatal risk assessment, referrals, and enhanced services.
• MCO manuals require completion and submission of the MPRA, linkage to home-visiting or case-management programs, and coverage of doula services, home visits, and community-based supports when included in the plan’s benefits.
• MCOs must allow continuity of care for pregnant members who were enrolled with an out-of-network provider for prenatal care, reimbursing at least the Medicaid FFS rate.

Maximize Your Maryland Medicaid Maternity Reimbursements with Expert BillingSupport from BillingFreedom

BillingFreedom has a proven track record of helping providers navigate Maryland Medicaid OB billing requirements. We ensure prenatal, delivery, postpartum, and enriched maternity services are billed correctly, following state-specific rules and MCO policies.

Our team understands that global maternity codes are not reimbursed in Maryland, and we help providers use individual E/M, delivery-only, postpartum, and enriched service codes accurately to maximize reimbursement.

We also support MPRA completion, risk assessment coordination, and linking members to MCO programs, reducing administrative burden and avoiding common denials.

With BillingFreedom, providers can minimize claim denials, stay compliant, and ensure timely payments, while focusing on patient care instead of navigating complex billing rules.

For more details about our exceptional OBGYN medical billing services in Maryland, 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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