Update to Maryland Medicaid Abortion Care Coverage

By November 18, 2024: Billing team must (1) Update billing software to recognize HCPCS codes S0190 ($75.00), S0191 ($5.00), and S0199 ($536.49) with correct reimbursement amounts for Maryland Medicaid FFS claims; (2) Configure system to route all abortion service claims and related inpatient/same-day hospital services to Medicaid FFS (not HealthChoice MCOs), while routing pre-procedure evaluation services to the MCO; (3) Implement claim requirements: use ICD-10 code for legally induced or failed attempted abortion as primary diagnosis, write 'Medical Abortion' in CMS-1500 Block 24D, and use date patient signed consent and took first medication as service date; (4) Ensure providers know S0199 includes all counseling, office visits, pregnancy testing, and ultrasounds—prohibit separate billing for office visits; (5) Update encounter forms and staff training. Providers should contact 1-800-456-8900 for questions. Failure to properly route claims or use correct codes will result in denials or payment delays.