News
PENNSYLVANIA REPRODUCTIVE HEALTH BILLING REQUIREMENTS UPDATE
Date: 07/22/24
Beginning March 1, 2024, the billing requirements are changing for Reproductive Health Services in the State of Pennsylvania. 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 | Description |
|---|---|
| AD | Life Endangerment |
| AF | Due To Emotional/Physical Health of Mother |
| AB | Incest |
| AA | Rape |
Non-Hyde Futile Pregnancy Procedures
| Condition Code | Description |
|---|---|
| AC | Due to serious fetal genetic defect, deformity, abnormality |
Claims for these services must be presented with a modifier code (Hyde Procedures* Only):
| Modifier | Description |
|---|---|
| G7 | Pregnancy resulted from rape or incest or pregnancy certified by physician as life-threatening |
- Procedures that are performed at 24 weeks or greater will not be covered.
- Procedures that are elective in nature will not be covered.
*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.