59614 Insurance Policy Changes

CPT 59614, in plain terms, covers Pays for the vaginal birth in a patient with a prior cesarean plus the postpartum care, used when this practice did not provide the prenatal visits. CPT 59614 is referenced in 14 tracked payer policy changes from Indiana Medicaid (IHCP), Healthfirst, and 9 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 59614 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 59614 on AAPC

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.
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.
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.
New Mexico Medicaid · Effective Jan 1, 2026Medium impact
Supplement 25-13: Birthing Options Program Billing and Reimbursement
Effective January 1, 2026, this Birthing Options Program (BOP) guidance supersedes Supplement 25-07 and sets a flat rate: the Medical Assistance Division reimburses the birth center one flat rate for labor and delivery and the newborn facility charge. Licensed Birth Centers keep the split billing model, with facility charges billed on the UB/837I format under provider type 405 and professional services billed on the CMS-1500 or 837P under provider types 322 and 323. No prior authorizations are required for BOP services.
Maryland Medicaid · Identified Jun 20, 2026Medium impact
General Provider Transmittal
Maryland Medicaid has delayed the implementation of General Provider Transmittal #56 indefinitely. Providers should NOT implement the previously announced changes to billing codes and modifiers that were scheduled to take effect February 1, 2002.
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.
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.

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REFERENCE DATA

Payers with rules1

Payers requiring prior auth1

Centene · Effective December 31, 2025
Prior authorization required
Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Centene require prior authorization for 59614?

Centene lists 59614 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 59614?

There are 14 tracked policy changes affecting CPT 59614, including updates from Indiana Medicaid (IHCP), Healthfirst, Blue Cross Blue Shield of Vermont. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 59614?

Payers that have issued tracked updates for CPT 59614 include: Indiana Medicaid (IHCP), Healthfirst, Blue Cross Blue Shield of Vermont, Nebraska Medicaid, MassHealth, Arkansas Medicaid, New Mexico Medicaid, Maryland Medicaid, Colorado Medicaid, Blue Cross Blue Shield of Rhode Island, Blue Cross of Idaho.

How do I get notified when CPT 59614 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 59614. 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 59614?

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 59614

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 59614 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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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

Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy

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

Supplement 25-13: Birthing Options Program Billing and Reimbursement

General Provider Transmittal

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

Hints for HEDIS

One to One for Healthcare Providers - Spring 2022

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

Prior authorization required

Does Centene require prior authorization for 59614?

What insurance policy changes affect CPT 59614?

Which payers have updated policy for CPT 59614?

How do I get notified when CPT 59614 policy changes?

Why do payers change policies for CPT 59614?