MedicaidDocumentationHigh impact
Updated HealthChoice Very Low Birth Weight Delivery Payment Policy and Billing Process, Effective April 5, 2023
Maryland Medicaid·MD · OB-GYN, Pediatrics·Provider Transmittal
Effective date
Apr 5, 2023
We identified it
Jun 20, 2026
Summary
Maryland HealthChoice removed the requirement to document progesterone therapy (17OHP/Makena or vaginal progestins) for Very Low Birth Weight (VLBW) delivery enhanced payments, effective April 5, 2023. Providers must now submit claims using regional procedure codes (MC001, MR001, or MS001) with U5 modifier and supporting documentation (VLBW Newborn Tracking Sheet, CMS 1500, and 4518a if applicable) to the MDH Office of Finance for infants weighing less than 1500 grams at 21+ weeks gestation.
Action Required
By April 5, 2023 (retroactive): (1) Billing team must update claim submission process to remove any requirement for progesterone documentation in VLBW delivery cases. (2) Update billing system to recognize regional procedure codes MC001 (Baltimore City), MR001 (Montgomery County), or MS001 (All Other Counties) with mandatory U5 modifier for all VLBW claims at the rate of $115,373.34. (3) Implement submission process to send encrypted VLBW Newborn Tracking Sheet, CMS 1500, and 4518a (adjustment claims only) monthly to mdh.mof@maryland.gov using correct naming convention (MCO/Provider Name_Patient MA ID#_Form Type_MonthYY). (4) Ensure all claims include ICD-10 diagnosis codes from P07-P07.15 (VLBW) and Z3A-Z3A.49 (Gestation) in Box 21 of CMS 1500. (5) Providers must verify birth records match submitted tracking sheets (date of birth, weight in grams, gestational age ≥21 weeks). (6) Contact MDH Office of Finance at mdh.mof@maryland.gov for submission issues or Provider Relations Call Center at (410) 767-5503/(800) 445-1159 Option 2 for claim denials. Failure to use correct regional codes, modifiers, and documentation will result in claim denials.