All Provider Bulletin 419: Transition to Separate Reporting of Maternity Care Services

By August 31, 2026: Billing team must implement workflow changes to distinguish patients by first prenatal visit date. (1) For patients with first prenatal visit BEFORE September 1, 2026: Continue billing CPT 59425 or 59426 as applicable. (2) For patients with first prenatal visit ON or AFTER September 1, 2026: Update billing system and encounter forms to use appropriate E/M codes (99202-99205 for new patients, 99211-99215 for established patients, 99221-99223 for inpatient initial, 99231-99236 for inpatient subsequent, 98000-98015 for telemedicine) with mandatory TH modifier appended. (3) Educate all providers and clinical staff that E/M code selection must be supported by documentation of medical decision-making level (straightforward, low, moderate, or high) based on problem complexity, data reviewed, and risk of complications. (4) Configure billing software to require TH modifier for all prenatal E/M codes to prevent claim denials. Failure to append TH modifier or use incorrect codes for new-patient encounters after September 1, 2026 will result in MassHealth claim denials.