MedicaidBilling CodesHigh impact
Healthfirst’s Obstetric Billing Guidelines Reimbursement Policy
Healthfirst·NY · OB-GYN·Coding
Effective date
Jun 1, 2026
We identified it
Jun 20, 2026
Summary
Healthfirst is transitioning from global obstetrical billing to encounter-based billing, requiring E/M codes with modifier TH for routine prenatal visits starting June 1, 2026. Global OB codes (59400, 59510, etc.) will no longer be accepted starting January 1, 2027.
Action Required
By June 1, 2026: Update billing system to use E/M codes (99202-99215) with modifier TH for routine prenatal visits for pregnancies initiated on/after June 1, 2026 or with due dates on/after January 1, 2027. By January 1, 2027: Completely stop using global OB codes (59400, 59510, 59425, 59426, etc.) - system must reject these codes. Update encounter forms to include modifier TH and pregnancy-related O/Z ICD-10 diagnosis codes. For MMC and HARP plans only: Submit Category II codes 0500F and 0503F on separate no-charge informational claims in real time.