MedicaidBilling CodesHigh impact
Healthy Start Procedure Code Changes
Maryland Medicaid·MD · OB-GYN, Pediatrics, Family Medicine·Provider Transmittal
Effective date
Feb 1, 2004
We identified it
Jun 20, 2026
Summary
Maryland Medical Assistance Program is transitioning from state-specific Healthy Start procedure codes (W1930-W1935, W9097) to nationally recognized HCPCS codes (H1001, H1002, H1004) for prenatal and pediatric case management services. The change requires specific modifiers and place of service codes for proper reimbursement.
Action Required
By February 1, 2004: Billing team must update system to use new HCPCS codes H1001, H1002, and H1004 for all Healthy Start services. Add modifier TH for pregnant women services and ensure correct place of service codes (12 for home visits, 71 or 11 for clinic visits). Continue using old W-codes only for services rendered before February 1, 2004. Update encounter forms and train staff on new code combinations for proper reimbursement.