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59510

PAYER POLICY CHANGES

59510 Insurance Policy Changes

CPT 59510, in plain terms, covers One bundled maternity charge for a baby born by cesarean that pays for the routine prenatal visits, the cesarean birth itself, and the postpartum care. CPT 59510 is referenced in 23 tracked payer policy changes from Blue Cross Blue Shield of Vermont, Michigan Medicaid - MDHHS, and 15 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 59510 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 59510 on AAPC

Blue Cross Blue Shield of Vermont · Effective Dec 1, 2026High impact
Preventive Care Reminder Sent to Members
Members receive the preventive services listed here at no cost when they align with USPSTF A- and B-rated services, ACIP vaccine recommendations, HRSA infant, child, adolescent and women's preventive guidelines, and Vermont state mandates. Covered procedure and diagnosis codes are listed for screenings, counseling, vaccines and preventive medications for children, adults and pregnant members, and some services require prior approval. Recent revisions add a Pre-Diabetes Preventive Interventions section for adults 18 and older, split mammography into diagnostic, ultrasound and MRI sections, and add pregnancy diagnosis codes effective 12/01/2026.
Michigan Medicaid - MDHHS · Effective Jan 1, 2027High impact
MMP 26-46: Updates to Coverage of Maternity Care Services
Effective January 1, 2027, Michigan Medicaid transitions from global maternity CPT codes (59400, 59510, 59620, 59425, 59426, 59430) to separate encounter-based E/M and obstetric procedure codes. Providers must append modifier TH and appropriate ICD-10-CM diagnosis codes to routine antepartum and postpartum E/M claims to qualify for enhanced reimbursement. Claims submitted with global codes on/after January 1, 2027 will only be paid if all service dates occurred by December 31, 2026.
Indiana Medicaid (IHCP) · Effective Jan 1, 2027High impact
BT2026180: IHCP announces updates to maternity codes due to nationally recognized changes
Starting Jan. 1, 2027, Indiana Medicaid (IHCP) will follow the AMA's revised CPT maternity codes, and the current maternity codes will no longer be valid for dates of service on or after that date. The IHCP will no longer accept global or bundled maternity billing on any claim, including when billed as secondary, so prenatal care, labor management, delivery and postpartum care must each be billed with the appropriate codes. Prenatal and postpartum visits will be billed as E/M codes with modifier TH and the trimester or postpartum modifier, and the new labor management and delivery codes replace the discontinued ones.
Healthfirst · Effective Jan 1, 2027High impact
Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy Effective January 1st, 2027
Healthfirst is moving obstetric billing from the historical global obstetrical payment model to a service-level, encounter-based framework. Beginning June 1, 2026, routine prenatal visits for certain pregnancies must be reported separately using the appropriate E/M code with modifier TH. Starting January 1, 2027, global obstetrical package codes will no longer be recognized for reimbursement.
Blue Cross Blue Shield of Vermont · Effective Jan 1, 2027High impact
CMO Corner: Important Changes to Global Maternity Care Coding and Billing
Effective January 1, 2027, maternity care coding transitions from global bundled codes to encounter-based billing with 17 deleted codes, 12 new codes, and 6 revised codes. Maternity services will now be billed separately by phase (antepartum, labor management, delivery, postpartum) instead of as one combined claim. For services spanning 2026-2027, specific transition codes and modifiers apply based on antepartum visit count.
Nebraska Medicaid · Effective Jan 1, 2027High impact
Maternity Service Unbundling
Nebraska Medicaid will retire 16 global maternity codes for dates of service on or after January 1, 2027, and move maternity care to E/M codes from 99202 to 99499 with the TH modifier. For antepartum visits where delivery is expected on or after that date, billing waits until after delivery, and Medicaid will allow a limited timely filing exception for certain earlier visits. New labor and delivery codes are also due January 1, 2027, with details expected in December 2026.
MassHealth · Effective Sep 1, 2026High impact
All Provider Bulletin 419: Transition to Separate Reporting of Maternity Care Services
Effective September 1, 2026, MassHealth requires providers to transition maternity care billing for new patients to evaluation and management (E/M) codes with TH modifier instead of global maternity CPT codes (59425, 59426, etc.). Existing patients with first prenatal visits before September 1, 2026 continue using legacy codes; new patients after that date must use appropriate E/M codes (99202-99205 for new patients, 99211-99215 for established patients, plus telemedicine codes) based on medical decision-making level.
Arkansas Medicaid · Effective Jul 9, 2026High impact
Obstetrics (OB) Services Billing Changes (Global) for PWUCH Members
Effective 7/9/2026, Arkansas Medicaid (PWUCH members only) requires obstetric services to be billed using global codes that bundle antepartum care, delivery, and 60-day postpartum care into a single charge. Postpartum visits are no longer separately reimbursable. Providers must use itemized billing only when less than 2 months of antepartum care was provided or the member lacked continuous Medicaid eligibility for the final 2 months before delivery. Updated reimbursement rates now apply to all global OB codes.
Harvard Pilgrim Health Care · Effective Jul 1, 2026High impact
Point32Health Payment Policy updates
Point32Health issued multiple payment policy updates effective 7/1/2026 affecting eight service categories across Harvard Pilgrim and Tufts Health plans. Most updates are minor administrative clarifications, but two require immediate billing changes: (1) Behavioral Health now prohibits billing psychological test codes (96130-96131) and neuropsychological test codes (96132-96133) together in the same episode of care—providers must select only the predominant service code; (2) Obstetrics/Gynecology (Tufts Health RITogether only) now allows doula service billing using specific HCPCS codes (S9445, S9446, 59510, 59400) with modifiers instead of S9445 alone.
Healthfirst · Effective Jun 1, 2026High impact
Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy
Healthfirst's Obstetric Billing Guidelines policy (PO-RE-132v5) moves maternity billing from the global obstetrical payment model to service-level, encounter-based billing for certain pregnancies beginning June 1, 2026. Starting January 1, 2027, global obstetrical package codes are no longer recognized for reimbursement, and antepartum and postpartum services must be reported using E/M codes. Routine prenatal E/M visits require modifier TH, and claims that do not follow the coding and billing requirements, including the prenatal E/M and TH modifier requirements, may be denied or rejected.
NY Medicaid · Effective Jun 1, 2026High impact
Obstetric Billing Changes for Prenatal Services Related to Upcoming Global Obstetric Fee Changes
Effective June 1, 2026, NYS Medicaid is transitioning from bundled global obstetric CPT codes to unbundled E/M codes with TH modifiers for prenatal services. All bundled obstetric codes (59400, 59425, 59426, 59510, 59610, 59618) will be deleted and unavailable on January 1, 2027. Billing teams must update systems, provider contracts, and documentation requirements to use E/M codes (99202-99205, 99211-99215, 99341-99350) with pregnancy-related O or Z ICD-10 codes and include CPT 0500F on initial prenatal visits.
Wisconsin Medicaid (ForwardHealth) · Effective Jan 1, 2026High impact
ForwardHealth Reimbursement Rate Increases
ForwardHealth (Wisconsin Medicaid/BadgerCare Plus) is increasing maximum allowable reimbursement rates for 7 service categories effective January 1, 2026, including dental anesthesia, home health visits, narcotic treatment services, obstetrics, personal care services, private duty nursing, and residential substance use disorder treatment. Billing teams must update fee schedules and ensure claims reflect the new rates starting 2026.
Arkansas Medicaid · Effective Jul 1, 2025High impact
REVISED - Obstetrics (OB) Services Billing Changes (Global/Itemized) and Postpartum Visits
Effective July 1, 2025, Arkansas Department of Human Services will no longer cover global OB codes unless beneficiaries have third-party liability insurance and/or Medicare. All OB services must be billed using itemized procedure codes (59409, 59425, 59426, 59514, 59612, 59620 for delivery/prenatal care) and postpartum visits must be billed as E&M codes with modifier TH. Eight previously bundled global OB codes are being terminated for non-TPL/non-Medicare beneficiaries.
Blue Cross Blue Shield of Vermont · Identified Sep 29, 2026High impact
Contraceptive Counseling Reminder
Blue Cross Vermont's preventive care benefit covers the screenings, vaccines, medications and counseling it lists at no cost when they align with the USPSTF, ACIP, HRSA and Vermont recommendations, and it lists the CPT, HCPCS and ICD-10-CM codes that qualify. Several revisions are already in effect: obstetric professional care after 09/01/2026 is billed with an E/M code and modifier -TH, branded oral contraceptives can only be dispensed when no commercially available generic equivalent exists, and the adult mammography, breast ultrasound and breast MRI sections added diagnosis codes including N63.15, N63.25 and Z12.31 effective 08/01/2026. Other revisions add pre-diabetes preventive interventions, a weight loss behavioral intervention section, influenza code 90616 to the adult vaccine section, diabetes screening age banding changed from 40 to 35, and pregnancy diagnosis codes with a 12/01/2026 effective date.
Wisconsin ForwardHealth · Effective Jan 1, 2026Medium impact
ForwardHealth Update 2025-28: ForwardHealth Reimbursement Rate Increases
ForwardHealth (Wisconsin Medicaid/BadgerCare Plus) has increased reimbursement rates for multiple service categories including dental anesthesia, home health visits, obstetrics, personal care, private duty nursing, narcotic treatment, and residential substance abuse treatment services. The updated fee schedules will be available on the ForwardHealth Portal.
Aetna · Identified Aug 19, 2026Medium impact
Home Births (CPB 0329, reviewed 2026-05-21)
Historical (last reviewed 05/21/2026): Aetna considers planned deliveries at home and associated services not medically appropriate. Coverage of home births will be considered only when mandated by law under plans subject to state mandates. The listed vaginal and cesarean delivery codes, newborn care in a setting other than a hospital or birthing center, nursing care in the home, and certain pregnancy and postpartum diagnosis codes are marked not covered for planned deliveries at home.
Medical Mutual of Ohio · Identified Jun 20, 2026Medium impact
Proper Documentation and Coding to Accurately Capture HEDIS PPC Measure
Medical Mutual of Ohio has released new documentation and coding requirements to improve capture of HEDIS PPC (Prenatal and Postpartum Care) measures. Billing teams must ensure prenatal visit codes are accompanied by pregnancy diagnosis codes and use specific CPT/ICD-10 codes for prenatal and postpartum care to reduce chart review requirements.
Colorado Medicaid · Identified Jun 20, 2026Medium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100463 - 05/2021)
Denied claims are corrected and resubmitted electronically as a new claim instead of being sent as a request for reconsideration, and resubmissions are not sent on paper even after the 365-day timely filing period. Half of all enrollment applications are returned to providers because of errors, and multiple infant deliveries are billed with modifier 59 instead of modifier 22, effective May 1, 2020. Physician-administered drugs on the listed set will require prior authorization no earlier than July 1, 2021.
Colorado Medicaid · Identified Jun 20, 2026Medium impact
Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300496 - 07/2023)
Most existing Health First Colorado member co-pays were reduced to $0 for listed services effective July 1, 2023, and claims with dates of service Previously due July 1, 2023 (date passed; verify current applicability) still carry the prior co-pays. DMEPOS claims paid by invoice are reimbursed at actual acquisition cost plus 23.59%, and claims paid by MSRP are reimbursed at MSRP less 15.49%, for dates of service on or after July 1, 2023. Ublituximab-xiiy and PANZYGA were added to the physician-administered drugs that require prior authorization, and mifepristone became available under the pharmacy benefit, both effective July 1, 2023.
L.A. Care Health Plan · Identified Jun 20, 2026Medium impact
Initial Health Appointment (IHA) for Newly Enrolled Medi-Cal Members
Medi-Cal members enrolled through the L.A. Care Direct Network must complete an Initial Health Appointment (IHA) in a primary care setting within 120 days of enrollment. The IHA can be completed over one or multiple visits and must be provided in a manner culturally and linguistically appropriate for the member. The letter states that the updated APL 22-030 removed the IHEBA/Staying Healthy Assessment requirement, but appropriate risk assessments and screenings should still be completed and documented. This is from a May 21, 2024 letter, so check current applicability with L.A. Care before applying it.
Blue Cross Blue Shield of Rhode Island · Identified Jun 20, 2026Medium impact
Hints for HEDIS
This HEDIS quality measure guidance provides specific CPT, HCPCS, and ICD-10 codes for documenting prenatal and postpartum care visits to ensure proper quality reporting. It outlines timing requirements (first trimester prenatal visits, postpartum visits between 7-84 days after delivery) and acceptable documentation standards.
Blue Cross of Idaho · Identified Jun 19, 2026Medium impact
One to One for Healthcare Providers - Spring 2022
Effective April 15, 2022, Blue Cross of Idaho will reinstate all authorization requirements and processes under PAP241, and all skilled nursing facility stays must go through the full authorization process with no automatic authorization of the first seven days. Prenatal and postpartum visits have listed CPT, CAT II, HCPCS and ICD-10-CM codes for billing, and submitting additional procedural and diagnostic codes separate from the payment bundle lets the plan identify pregnant members early. Beginning June 2022, Blue Cross of Idaho will rely on NPPES as the system of record for individual practitioner names, and a name that does not match NPPES may change the provider profile and provider directory listing.
Blue Cross of Idaho · Identified Jun 19, 2026Medium impact
PAP304 - Prenatal and Postpartum Care Coding for HEDIS Quality - New
Blue Cross of Idaho has introduced new coding guidelines for prenatal and postpartum care to support HEDIS quality measures. The policy establishes specific documentation requirements and billing codes for prenatal visits (first 12 weeks of pregnancy) and postpartum visits (7-84 days after delivery) to ensure proper quality measure reporting.

Watch 59510

Get one email when a payer policy names 59510, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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REFERENCE DATA

Payers with rules3

Payers requiring prior auth3

CountyCare Health Plan · Effective April 23, 2026
Prior authorization required
CountyCare Prior Authorization Look-Up Tool (All Codes)
CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements
Community Health Plan of Imperial Valley · Effective December 31, 2025
Prior authorization required
Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 59510?

CalViva Health lists 59510 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 59510?

Community Health Plan of Imperial Valley lists 59510 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CountyCare Health Plan require prior authorization for 59510?

CountyCare Health Plan lists 59510 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans (list dated April 23, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 59510?

There are 23 tracked policy changes affecting CPT 59510, including updates from Blue Cross Blue Shield of Vermont, Michigan Medicaid - MDHHS, Indiana Medicaid (IHCP). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 59510?

Payers that have issued tracked updates for CPT 59510 include: Blue Cross Blue Shield of Vermont, Michigan Medicaid - MDHHS, Indiana Medicaid (IHCP), Healthfirst, Nebraska Medicaid, MassHealth, Arkansas Medicaid, Harvard Pilgrim Health Care, NY Medicaid, Wisconsin Medicaid (ForwardHealth), Wisconsin ForwardHealth, Aetna, Medical Mutual of Ohio, Colorado Medicaid, L.A. Care Health Plan, Blue Cross Blue Shield of Rhode Island, Blue Cross of Idaho.

How do I get notified when CPT 59510 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 59510. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 59510?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 59510

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 59510 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Preventive Care Reminder Sent to Members

MMP 26-46: Updates to Coverage of Maternity Care Services

BT2026180: IHCP announces updates to maternity codes due to nationally recognized changes

Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy Effective January 1st, 2027

CMO Corner: Important Changes to Global Maternity Care Coding and Billing

Maternity Service Unbundling

All Provider Bulletin 419: Transition to Separate Reporting of Maternity Care Services

Obstetrics (OB) Services Billing Changes (Global) for PWUCH Members

Point32Health Payment Policy updates

Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy

Obstetric Billing Changes for Prenatal Services Related to Upcoming Global Obstetric Fee Changes

ForwardHealth Reimbursement Rate Increases

REVISED - Obstetrics (OB) Services Billing Changes (Global/Itemized) and Postpartum Visits

Contraceptive Counseling Reminder

ForwardHealth Update 2025-28: ForwardHealth Reimbursement Rate Increases

Home Births (CPB 0329, reviewed 2026-05-21)

Proper Documentation and Coding to Accurately Capture HEDIS PPC Measure

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2100463 - 05/2021)

Health First Colorado (Colorado's Medicaid Program) News and Updates (B2300496 - 07/2023)

Initial Health Appointment (IHA) for Newly Enrolled Medi-Cal Members

Hints for HEDIS

One to One for Healthcare Providers - Spring 2022

PAP304 - Prenatal and Postpartum Care Coding for HEDIS Quality - New

Prior authorization required

Prior authorization required

Prior authorization required

Does CalViva Health require prior authorization for 59510?

Does Community Health Plan of Imperial Valley require prior authorization for 59510?

Does CountyCare Health Plan require prior authorization for 59510?

What insurance policy changes affect CPT 59510?

Which payers have updated policy for CPT 59510?

How do I get notified when CPT 59510 policy changes?

Why do payers change policies for CPT 59510?