How to Bill for Medicaid

Medicaid Patients

According to the Medicaid Provider Reimbursement Handbook, the Healthy Start Prenatal Risk Screening must be offered at the first prenatal visit. The prenatal visit that includes completion of the Healthy Start Prenatal Risk Screening is reimbursed once per pregnancy by billing procedure code H1001. Only if the patient consents to Healthy Start screening will you receive reimbursement for the screen.

If the Healthy Start Prenatal Risk Screening is completed during the FIRST trimester, procedure code H1001 with modifier TG should be billed.

H1001 is included in the total number of prenatal visits which is 10 prenatal visits for a low-medical risk pregnancy and 14 prenatal

visits for a high medical-risk pregnancy. Do not bill H1001 with a modifier 22 as this is not a valid modifier for this code.

The provider must retain a copy of the Healthy Start prenatal Risk Screening form in the recipient’s medical record to indicate that the screening was completed. If the recipient declines the Healthy Start Prenatal Risk Screening form, the provider must document the refusal in the recipient’s medical record, and bill for an antepartum visit (procedure code H1000) instead of an ante partum visit plus Healthy Start Prenatal Risk Screening.

Do not submit the Healthy Start Prenatal Risk Screening form with the CMS-1500 claim form.

For additional information, see Chapter 2 in the Florida Medicaid Physician Services Coverage and Limitations Handbook.