Effective April 15, 2025, providers are required to submit a claim with a Category II CPT code for each prenatal/postpartum service provided to a NYS Medicaid member when the provider is billing using the global bill codes. These Category II CPT code claims are in addition to the global code.
The following Category II CPT Codes must be included on a claim: 0500F (Initial Prenatal Visit), 0502F (Subsequent Prenatal Visit) or 0503F (Postpartum visit) for each corresponding visit provided to the patient within the obstetric global period being billed (see example below). Claims submitted without the appropriate Category II CPT codes will be denied.
Example: Member with 8 prenatal visits, 1 post-partum visit, and routine vaginal delivery would be reported:
- 1 unit CPT 59400.
- 1 unit of CPT 0500F.
- 7 units of CPT 0502F.
- 1 unit of CPT 0503F.
For details, see EmblemHealth’s Coding Edits Reimbursement Policy.
