MedicaidCoverageHigh impact
Abortion Services for HealthChoice Enrollees
Maryland Medicaid·MD · OB-GYN, Family Medicine, General Surgery·General Provider
Effective date
Mar 9, 1998
We identified it
Jun 20, 2026
Summary
For Maryland Medicaid HealthChoice enrollees, abortion services are no longer covered under MCO capitation payments and must be billed directly to the state Medicaid program on a fee-for-service basis. All abortion claims require a completed DHMH 521 Certification form and must meet specific coverage criteria including medical necessity or rape/incest documentation.
Action Required
Immediately: For Maryland Medicaid HealthChoice members, stop billing MCOs for abortion services (CPT codes 59840-59866). Submit all abortion claims directly to Medical Care Operations Administration, P.O. Box 1935, Baltimore, MD 21203 with completed DHMH 521 Certification form signed by performing physician. Ensure claims include appropriate ICD-9 diagnosis codes (635.00-635.92, 637.00-638.92) and document medical necessity meeting one of six coverage criteria. Claims without proper certification will be denied.