Medicine and Surgery Section - Wisconsin.gov

Appendix 9
Antepartum Care Claims Submission Guide
Providers should refer to the following table as a guide for submitting claims for a specific number of antepartum care visits.
Providers should provide all antepartum care visits before submitting a claim to Wisconsin Medicaid.
Indicate procedure codes 99204 with modifier “TH” and 99213 with modifier “TH” when submitting claims for one to three
total antepartum care visits with the same provider or provider group. For example, if a total of two or three antepartum care
visits is performed during a woman’s pregnancy, the provider should indicate procedure code 99204 with modifier “TH” and
a quantity of “1.0” for the first date of service (DOS). For the second and third visits, the provider should indicate procedure
code 99213 with modifier “TH” and a quantity of “1.0” or “2.0,” as indicated in the table. The date of the last antepartum
care visit is the DOS.
Similarly, for CPT codes 59425 (antepartum care only; 4-6 visits) and 59426 (antepartum care only; 7 or more visits), the
provider should indicate the date of the last antepartum care visit as the DOS. The quantity indicated for these two codes
may not exceed “1.0.”
Refer to the Surgery Services chapter of this section for more information on submitting claims for obstetric care using
separate obstetric component procedure codes versus global obstetric procedure codes.
Total
Visit(s)
1
2
3
Antepartum Care Claims Submission Guide
Procedure Code and Description*
99204
Office or other outpatient visit for the evaluation and management
of a new patient … Usually, the presenting problem(s) are of
moderate to high severity. Physicians typically spend 45 minutes
face-to-face with the patient and/or family.
Modifier
and
Description
TH
(Obstetrical
treatment/
services,
prenatal or
postpartum)
Quantity
99204 TH 1.0
99213
Office or other outpatient visit for the evaluation and management
of an established patient … Usually, the presenting problem(s) are
of low to moderate severity. Physicians typically spend 15 minutes
face-to-face with the patient and/or family.
99204 TH 1.0
99213 TH 2.0
4-6 59425 Antepartum care only; 4-6 visits 1.0
7+ 59426 7 or more visits 1.0
*Refer to Current Procedural Terminology for a complete description of procedure codes 99204 and 99213.
Physician Services Handbook — Medicine and Surgery December 2005 91
TH
1.0
1.0
Appendix