MedicaidBilling CodesHigh impact
Billing for Prenatal/Postpartum Visits
EmblemHealth·NY · OB-GYN·Reimbursement
Effective date
Apr 15, 2025
We identified it
Jun 27, 2026
Summary
Effective April 15, 2025, EmblemHealth now requires Category II CPT codes (0500F, 0502F, or 0503F) to be included on all claims for prenatal and postpartum services billed with global codes for New York Medicaid members. Claims submitted without the appropriate Category II code will be denied.
Action Required
By April 15, 2025: Billing team must update billing system to require one of the three Category II CPT codes (0500F for initial prenatal visits, 0502F for subsequent prenatal visits, or 0503F for postpartum visits) on every claim using global obstetric billing codes for New York Medicaid members. Update encounter forms and provider templates to prompt selection of the appropriate Category II code based on visit type. Train billing staff and providers on the new requirement. Claims submitted without these codes will be denied by EmblemHealth.