MedicaidAdministrativeMedium impact
HealthChoice Very Low Birth Weight Delivery Payment Policy and Billing Process Effective January 1, 2018
Maryland Medicaid·MD · OB-GYN, Pediatrics·Provider Transmittal
Effective date
Jan 1, 2018
We identified it
Jun 20, 2026
Summary
Maryland HealthChoice updated their Very Low Birth Weight (VLBW) delivery payment policy effective January 1, 2018, establishing specific billing procedures, diagnosis codes (P07-P07.15, Z3A-Z3A.49), procedure codes (MC001, MR001, MS001), and documentation requirements for VLBW deliveries under 1500 grams. MCOs must submit monthly encrypted forms including VLBW Newborn Tracking Sheet, CMS 1500, and 4518a forms to MDH via email with specific naming conventions.
Action Required
Immediately: Billing team must update Maryland Medicaid VLBW claims to use specific procedure codes (MC001 for Baltimore City, MR001 for Montgomery County, MS001 for all other counties) with ICD-10 diagnosis codes P07-P07.15 and Z3A-Z3A.49. Submit monthly encrypted documentation including VLBW Newborn Tracking Sheet, CMS 1500, and 4518a forms to mdh.mof@maryland.gov using required naming convention. Check claim status via eMedicaid weekly remittance advice.