DELAWARE REPRODUCTIVE HEALTH BILLING REQUIREMENTS UPDATE

Date: 08/08/24

Beginning March 1, 2024, the billing requirements are changing for Reproductive Health Services in the State of Delaware. Claims will adjudicate in accordance with state and federal laws. Claims received prior to the date of this publication will require a corrected claim to accurately reflect the service as detailed below. The below information offers further detail on specifics that are required to review and adjudicate the claim appropriately.

The following procedure codes are impacted by these changes:

Claims for these services must be presented with a condition code:

Hyde Procedures* 

Claims for these services must be presented with a modifier code (Hyde Procedures* Only):

Hyde Procedures* 

Non-Hyde Futile Pregnancy Procedures

Fetal Viability Review will be conducted for Hyde and Non-Hyde Procedures:

Hyde Procedures (As a result of Rape or Incest)

*Hyde Procedures are cases involving rape, incest, or when the continuation of the pregnancy would endanger the mother’s life. 
**Non-Hyde procedures are cases involving an elective procedure or cases not included as a Hyde procedure.