Name of Manual - Blue Cross and Blue Shield of Minnesota

Coding Policies and Guidelines (Maternity)
Pre-term Birth
Prevention Services
11-4
Blue Cross will reimburse for certain pre-term birth prevention
services when the patient’s contract covers these services.
Code Narrative Billing
H1000 Prenatal Care, at-risk assessment
[use the Minnesota Pregnancy
Assessment Form, DHS 3294 (1/97)
to complete assessment or the
American College of Obstetrics and
Gynecology (ACOG) pregnancy
assessment form]
H1001 Prenatal care, at-risk enhanced
service; antepartum management
H1003 Prenatal care, at-risk enhanced
services; education
Done twice for
all patients; once
at initial OB visit
and once at 24-
28 weeks.
If the patient is
identified via the
assessment as
high risk. This
code may be
billed once.
If the patient is
identified via the
assessment as
high risk. This
code may be
billed once.
The services represented by the prenatal care at-risk codes H1002,
H1004 and H1005 are already included in the provider’s normal
prenatal care and not separately reimbursed.
Please refer to Chapter 4 Case Management for information on
the Minnesota Pregnancy Assessment Form.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/20/12)