MedicaidBilling CodesHigh impact
Billing Prenatal/Postpartum Visits for Medicaid Members
EmblemHealth·NY · OB-GYN·Reimbursement
Effective date
Apr 15, 2025
We identified it
Jun 20, 2026
Summary
Starting April 15, 2025, providers must submit additional Category II CPT codes (0500F, 0502F, 0503F) for each prenatal and postpartum visit when billing NYS Medicaid members using global obstetric codes. Claims without these additional codes will be denied.
Action Required
By April 15, 2025: Billing team must update system to automatically include Category II CPT codes with all obstetric global bills for NYS Medicaid members. Add 0500F for initial prenatal visits, 0502F for subsequent prenatal visits, and 0503F for postpartum visits. Update encounter forms and EMR templates to capture visit types. Train staff on new requirements as claims will be denied without these codes.