MedicaidCoverageMedium impact
Coverage of Home Visiting Services for HealthChoice and Medicaid Fee-for-Service Enrollees, Effective January 13, 2022
Maryland Medicaid·MD · OB-GYN, Family Medicine, Pediatrics·Provider Transmittal
Effective date
Jan 13, 2022
We identified it
Jun 20, 2026
Summary
Maryland Medicaid is expanding coverage for evidence-based home visiting services (HFA and NFP programs) effective January 13, 2022, to all HealthChoice MCO and Fee-for-Service enrollees who are pregnant or have infants under 90 days old. Billing teams must begin accepting CPT code 99600 claims at $188 per visit (in-person, community, or telehealth), with specific place-of-service and modifier requirements. Prior authorization is not required.
Action Required
By January 13, 2022 (already effective): Billing team must configure the billing system to accept and process CPT code 99600 claims at the $188 per-visit rate for Maryland Medicaid (both HealthChoice MCO and Fee-for-Service). Configure place-of-service coding: use code 4/12 for home visits in patient homes, code 99 for community-based visits, and code 12 with GT modifier for telehealth visits. Update encounter forms and provider education to reflect that CPT 99600 can be billed once per week per eligible participant. Ensure claims are not rejected for lack of prior authorization—none is required. Train billing staff that eligibility requires: (1) HealthChoice MCO or Medicaid FFS enrollment, (2) pregnant status or infant under 90 days old, and (3) for NFP only, no previous live births. Verify that HVS providers in your network are HFA-accredited or NFP-fidelity-designated. Confirm infant and prenatal/postpartum Medicaid enrollment requirements are met before processing claims. Claims submitted without proper place-of-service or modifier coding may be denied.