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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:

Reproductive Health Procedure Codes
59414, 59812, 59820, 59821, 59840, 59841, 59850, 59851, 59852, 59855, 59856, 59857, 59866, S0190, S0199, S2260, S2265, S2266, S2267, 59870, 59830


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

Hyde Procedures* 

Condition Code DescriptionDescription
ADLife Endangerment
ABIncest
AARape

 

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

Hyde Procedures* 

Condition Code
Description
ADLife Endangerment
AFDue To Emotional/Physical Health of Mother
ABIncest
AARape


Non-Hyde Futile Pregnancy Procedures

Condition CodeDescription
ACAC Due to serious fetal genetic defect, deformity, abnormality


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

Hyde Procedures (As a result of Rape or Incest)

Gestational AgeMedical Records Required
23 weeks or greater Yes

 

*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.