For Dates of Service Before January 1, 2009

Procedure Codes

^*Providers are required to use modifier "TH" with procedure codes 99204 and 99213 only when those codes are used to indicate the first three antepartum care visits. Providers are required to use both modifiers "TH" and HPSA modifier "AQ" when these prenatal services are HPSA eligible for appropriate reimbursement.

^**This procedure code must be submitted on a paper 1500 Health Insurance Claim Form with documentation attached to the claim showing medical necessity. This code should be billed by a certified nurse midwife only in POS "12" (Home) when the certified nurse midwife attends the labor of a patient and subsequently admits the patient to the hospital for the delivery.