COMPREHENSIVE PERINATAL SERVICES PROGRAM Service ...

COMPREHENSIVE PERINATAL SERVICES PROGRAMService Codes and Reimbursement ScheduleThe following are the Comprehensive Perinatal Provider service codes effective August 1, 2000 for Nutrition, Health Education, and Psychosocial services.ProcedureCode Description When to UseZ6500 2Initial Comprehensive Nutrition,Psychosocial, and Health EducationAssessments and Development of CarePlan within 4 weeks of entry into care 3 ,Individual, first 30 minutes of eachAssessment (90 minutes total), includingongoing coordination of care. InitialPregnancy-related exam (Z1032) mustalso be completed within this 4 weekperiod.Initial CPSP Assessment completedwithin 4 weeks of Initial PrenatalExam (Z1032). This 90 minutes isfor Health Educ., Nutrition, andPsychosocial initial assessment timeonly - does not include ClientOrientation.MaximumUnits ofServiceReimbursementper Unit ofService1 $135.83 $135.83MaximumReimbursement 1NUTRITION CODESZ6200Initial Nutrition Assessment andDevelopment of Care Plan, Individual,first 30 minutes.For first 30 minutes of InitialNutrition Assessment when InitialCPSP Assessment not completedwithin 4 weeks of Initial PrenatalExam (Z1032).1 $16.83 $16.83Z6202Initial Nutrition Assessment anddevelopment of Care Plan, Individual,each Subsequent 15 minutes (Maximumof 1 ½ hours)1) Time spent doing initialassessment exceeded 30 minutes innutrition component (either Z6500 orZ6200 used);2) “Entirely new problem” diagnosedlater in pregnancy requiring a newnutrition assessment, e.g.gestational diabetes.6 $8.41 $50.46Z6204Follow-up Antepartum NutritionAssessment, Treatment, and/orIntervention, Individual, each 15 minutes(Maximum of 2 hours)Trimester reassessments;antepartum counseling, such as byRD consultant.8 $8.41 $67.28

Z6206Follow-up Antepartum NutritionAssessment, Treatment, and/orIntervention, Group, per patient, each 15minutes (Maximum of 3 hours)Nutrition information provided in agroup class.12 $2.81 $33.72Z6208Postpartum Nutrition Assessment,Treatment, and/or Intervention, includingupdate of Care Plan, Individual, each 15minutes (Maximum of 1 hour)1) Postpartum nutrition assessment;2) Postpartum nutrition intervention,e.g. assistance with breastfeeding4 $8.41 $33.64Z6210Prenatal Vitamin-Mineral Supplement,300 Day SupplyPrenatal vitamins dispensed byoffice; cannot bill until all 300 havebeen dispensed1 $39.96 $39.96PSYCHOSOCIAL CODESZ6300Initial Psychosocial Assessment andDevelopment of Care Plan, Individual,first 30 minutesFor first 30 minutes of InitialPsychosocial Assessment whenInitial CPSP Assessment notcompleted within 4 weeks of InitialPrenatal Exam (Z1032).1 $16.83 $16.83Z6302Initial Psychosocial Assessment andDevelopment of Care Plan, Individual,each subsequent 15 minutes (Maximumof 1 ½ hours)1) Time spent doing initialassessment exceeded 30 minutes inpsychosocial component (eitherZ6500 or Z6300 used);2) “Entirely new problem” diagnosedlater in pregnancy requiring a newpsychosocial assessment, e.g.domestic violence.6 $8.41 $50.46Z6304Follow-up Antepartum PsychosocialAssessment, Treatment, and/orIntervention, Individual, each 15 minutes(Maximum of 3 hours)Trimester reassessment;antepartum counseling or otherintervention, such as by social workconsultant.12 $8.41 $100.92Z6306Follow-up Antepartum PsychosocialAssessment, Treatment, and/orIntervention, Group, per patient, each 15minutes (Maximum of 4 hours)Psychosocial information providedin a group class.16 $2.81 $44.962

Z6308Postpartum Psychosocial Assessment,Treatment, and/or Intervention, includingupdate of Care Plan, Individual, each 15minutes(Maximum of 1½ hours)1) Postpartum psychosocialassessment;2) Postpartum psychosocialintervention, e.g. postpartumdepression6 $8.41 $50.46HEALTH EDUCATION CODESZ6400 Client Orientation, Individual, each 15minutes (Maximum of 2 hours)Initial individual orientation(required); orientation requiredduring pregnancy, e.g. when patientis referred to hospital for non-stresstest.8 $8.41 $67.28Z6402Initial Health Education Assessment andDevelopment of Care Plan, Individual,first 30 minutesFor first 30 minutes of Initial HealthEducation Assessment when InitialCPSP Assessment not completedwithin 4 weeks of Initial PrenatalExam (Z1032).1 $16.83 $16.83Z6404Initial Health Education Assessment andDevelopment of Care Plan, Individual,each subsequent 15 minutes (Maximumof 2 hours)1) Time spent doing initialassessment exceeded 30 minutes inhealth education component (eitherZ6500 or Z6402 used);2) “Entirely new problem” diagnosedlater in pregnancy requiring a newhealth education assessment.8 $8.41 $67.28Z6406Follow-up Antepartum Health EducationAssessment, Treatment, and/orIntervention, Individual, each 15 minutes(Maximum of 2 hours)Trimester reassessment;antepartum counseling or otherintervention, such as by healtheducation consultant.8 $8.41 $67.28Z6408Follow-up Antepartum Health EducationAssessment, Treatment, and/orIntervention, Group, per patient, each 15minutes(Maximum of 2 hours)Health education provided in agroup class.8 $2.81 $22.483

Z6414Postpartum Health EducationAssessment, Treatment, and/orIntervention, including update of CarePlan, Individual, each 15 minutes(Maximum of 1 hour)1) Postpartum health educationassessment;2) Postpartum health educationintervention.4 $8.41 $33.64PERINATAL EDUCATION CODES(Can be used antepartum or postpartum)Z6410 Perinatal Education, Individual, each 15minutes (Maximum of 4 hours)Individual education providedprenatally or postpartum.16 $8.41 $134.56Z6412Perinatal Education, Group, per patient,each 15 minutes (Maximum 4hours/day,18 hours/pregnancy)Group education, e.g. childbirtheducation (Lamaze)72 $2.81 $202.32CPSP OB BONUSESZ1032-ZLInitial Comprehensive Pregnancy-relatedoffice visit performed within 16 weeks ofLMPInitial prenatal exam done prior to17 weeks LMP. If non-physicianpractitioner (NP, PA, CNM) doesexam, see M/C Provider Manual forappropriate modifier.1 $56.63 $56.63Z1036 Tenth Antepartum Office Visit One time only when 10 th antepartumvisit performed.1 $113.26 $113.261 Additional reimbursement is subject to prior approval using a Medi-Cal Treatment Authorization Request (TAR).2 If Z6500 is used, codes Z6200, Z6300, and Z6402 cannot be used because the first 30 minutes of each assessment is already included in Z6500.However, additional initial assessment time can be billed under codes Z6202, Z6302, or Z6404.3 Entry into care is the time of the first billable pregnancy-related office visit or initial support service assessment.Billing Codes Handout.docRev. 4/8/054