Coverage for Centering Pregnancy Group Prenatal Care

Effective July 1, 2017, the South Carolina Department of Health and Human Services (SCDHHS) will update coverage for CenteringPregnancy group prenatal care services.

CenteringPregnancy is a model of prenatal care provided in a group setting that gives patients more time with their provider and encourages interaction with other expectant mothers. Through this service, participants meet to discuss maternal and infant health as a group while receiving clinical supervision and support. To qualify for the benefit, a Medicaid member must be a female between the ages of 12 and 55 years of age.

Billing and Reimbursement

The Centering Healthcare Institute certifies providers offering CenteringPregnancy programs. To qualify for reimbursement for CenteringPregnancy group clinical visits, a provider must be a site approved by the Centering Healthcare Institute or be under the Centering grant contract through SCDHHS in preparation for formal site approval, and the provider must provide group prenatal care utilizing the CenteringPregnancy model.

Group clinical visits must last at least 1.5 hours, with a minimum of two clients and a maximum of 20 clients. Following the recommended CenteringPregnancy model, up to 10 group clinical visits prior to delivery may be covered. Providers must use educational materials from the CenteringPregnancy curriculum, and these must be incorporated into the educational portion of the group clinical visit.

Providers must submit a claim for a group clinical visit for the management of pregnancy using procedure code 99078 and modifier TH. The claim must include a pregnancy diagnosis code (ICD-10 series Z34- for normal pregnancy, and ICD-10 series O09- for high-risk pregnancy).

For claims with procedure code 99078 with modifier TH to be eligible for reimbursement, they must be submitted for the same date of service as claims by the same provider for an established patient visit (E/M procedure codes 99211, 99212, 99213, 99214, or 99215) with modifier TH.

The Centering Healthcare Institute lists sites in South Carolina currently approved to provide CenteringPregnancy services on its webpage. For more information please visit the website at https://centeringhealthcare.secure.force.com/WebPortal/ListOfCenteringSi....

If you have any questions regarding this policy, please contact the Provider Service Center at (888) 289-0709. Thank you for your continued support of the South Carolina Healthy Connections Medicaid program.

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