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Elizabeth M. Whitehorn, Director

Provider Notice Issued 07/27/2022

Date:   July 27, 2022

To:       All Medical Assistance Program Providers

Re:      Clarification of Reimbursement for Postpartum Visits

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This notice clarifies coverage of postpartum visits as described in the December 21, 2021, provider notice. This policy applies to both Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care organization (MCO) plans.

The Medicaid benefit package includes coverage for a postpartum visit within the first 3 weeks after a pregnancy ends and within 4 to 12 weeks after a pregnancy ends. These visits are covered regardless of whether a pregnancy ends in childbirth, stillbirth, miscarriage, or abortion. Providers may bill the same procedure code, 0503F – Postpartum Care Visit, twice during the postpartum period and be reimbursed in accordance with the Act.

This policy is retroactive to dates of service beginning October 8, 2021. Questions concerning this coverage may be directed to the Bureau of Professional and Ancillary Services at
877-782-5565 or the applicable HCI MCO plan.

 
Kelly Cunningham, Administrator
Division of Medical Programs