Billing and Reimbursement Guidelines
Additional maternity payments
Through our Maternity Care Program, our network obstetric providers can earn payments on top of regular reimbursements for maternity care.
Getting paid is easy. This chart outlines how to get the extra payments:
| Type of Visit | Prenatal | Postpartum | Mental Health Screening |
|---|---|---|---|
| Timeframe for visit | During the first trimester of pregnancy or within 42 days of the patient's BlueCare Tennessee or CoverKids enrollment | Within seven to 84 days of delivery | At least once during the perinatal period using a standardized tool for depression and anxiety |
| Steps to Receive Payment |
Bill the visit using category II code 0500F, and please remember to:
|
Bill the visit using category II code 0503F, and please remember to:
Note: We'll allow for reimbursement of two claims for code 0503F during the 84-day postpartum period. |
Bill CPT® 96160 with a TH modifier to show you completed the service, and please remember to:
Note: No specific diagnosis code is required for payment. |
| Reimbursement | $25 per patient | $75 per patient/per claim | $28.35 per patient |
*All other billing and processing guidelines apply, including prior authorization requirements, coordination of benefits and timely filing. Additionally, all claims submitted are subject to retrospective claims review and possible recovery. For more information about billing guidelines, please see the BlueCare Tennessee Provider Administration Manual.
*Review detailed sample billing guidance and scenario-specific instructions on billing 0500F here.
Lactation Consultant Benefits
Help with breastfeeding
Effective June 1, 2023, your patients with BlueCare℠, TennCareSelect and CoverKids coverage have lactation benefits. These benefits include medically appropriate lactation consultant services from in-network providers during pregnancy and the extended postpartum period. Parents can get services through telehealth or in person in a one-on-one or small group setting.
Billing for Lactation Services
International Board-Certified Lactation Consultants (IBCLCs) can submit claims for eligible services. Certified Lactation Counselors (CLCs), Certified Lactation Educators (CLEs), Certified Lactation Specialists (CLSs) and Certified Breastfeeding Specialists (CBSs) can provide services with the supervision of a licensed, in-network provider. The supervising provider must be listed on claims.
When billing for lactation services, please use the appropriate codes below plus the modifier U8:
- 98960 U8 [single individual per 30 min.]
- 98961 U8 [2-4 patients per 30 min.]
- 98962 U8 [5-8 patients per 30 min.]
Please also note the number of units to signify the length of the visit:
- 1 unit = visit 16-45 min.
- 2 units = visit 46-75 min.
- 3 units = visit 76-105 min.
There's no limit on the number of lactation consultant visits allowed, but we may request more information after 15 units are billed.
Pregnancy and Postpartum Care
Specialized support for your patients
Your patients' BlueCare Tennessee and CoverKids benefits are designed to support families during pregnancy and after birth.
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Our care team
Our dedicated care team is here for our members through pregnancy and delivery. Care team support includes access to personalized health information, help scheduling appointments, care coordination, connection to community agencies, and extra support if they're at risk for an early delivery or complications.
Your patients with BlueCare Tennessee and CoverKids coverage can connect with their dedicated care team by downloading the CareTN app or calling 1-888-416-3025. Those who participate in our maternity program and use the CareTN app may be eligible to earn gift cards they can use to purchase baby supplies.
Please let your patients with BlueCare Tennessee coverage know about our care team and maternity program. You and your patients can learn more on our Pregnancy Support page. This webpage contains everything our members need to know about their benefits, including maternity gift card requirements, and how we can support them at all stages of their maternal health journey.*
* Note: Gift card amounts and eligibility requirements are subject to change.
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No-cost breast pump
Your patients with BlueCare Tennessee or CoverKids coverage can get a no-cost electronic breast pump through Aeroflow Breastpumps. You'll need to write a prescription for the breast pump, and patients can order it online once they get a prescription.
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Telehealth benefits
When appropriate, telehealth services can make it easier for new and expecting parents to access care and supportive services. Review our Managing Telehealth for Patients During and After Pregnancy guide for more about our telehealth policies.
TennCare Diaper Benefit
Effective Aug. 7, 2024, your patients can get up to 100 diapers per month at no cost from an approved list of products until age 2. View the list of participating pharmacies and approved diapers, which include different brands and types.
Prenatal Vaccines
Protection for pregnant patients and babies
Vaccines during pregnancy help safeguard against illnesses and potentially serious complications.
Review our Vaccines During Pregnancy infographic to learn more.
Vaccines During Pregnancy
Legislative updates for OB providers
New Tennessee legislation took effect on July 1, 2025, expanding mandatory prenatal screenings for syphilis and hepatitis. It also requires hospitals and birth centers to discuss post-birth warning signs with patients before discharge. Review the Tennessee Department of Health memo for more about these guidelines.
ADDITIONAL POSTPARTUM RESOURCES
Ongoing support after pregnancy
During the postpartum period, it's important for patients to keep in close contact with their OB and primary care providers. Follow-up visits during the postpartum period help identify and address problems, including postpartum depression and anxiety.
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Postpartum Visit Frequency
The American College of Obstetricians and Gynecologists recommends patients follow up with their OB provider three weeks after birth and then have a comprehensive exam at 12 weeks. Two visits after birth offer key opportunities to screen for problems. They're also great times to begin the transition back to primary care for continued monitoring and referrals to specialists as needed.
Providers are eligible to get extra payments on top of regular reimbursements for two postpartum visits when certain criteria are met. See the Additional maternity payments section of this webpage for more information.
We also offer care management services, including our CareTN program, which focuses on chronic conditions and behavioral health.
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Mental Health Resources
- Stigma Training:
- March of Dimes - Beyond Labels Substance Use Disorder Stigma Reduction Tools and Training
- MakeitOK.org - Stigma Training Around Mental Illness
- National Alliance on Mental Illness - Black/African American Communities
- Mental Health America - Black, Indigenous, People of Color (BIPOC) Mental Health
- Anxiety & Depression Association of America - Black and African American Communities
- Health Resources & Services Administration - National Maternal Mental Health Hotline (1-833-9-HELP4MOMS (943-5746)
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Medications and Pregnancy
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Dental Care and Pregnancy
- American Dental Association webpage dedicated to the care of pregnant women
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