Global Maternity Claims
Global maternity involves the billing process for maternity-related claims for a beneficiary. Once a beneficiary has been diagnosed as pregnant, all charges related to the pregnancy are grouped under one global maternity diagnosis code.
These diagnosis codes will be listed as the primary diagnosis when billing. Figure 8.1 on the following
page lists examples of these codes.
Global Maternity Diagnosis Code Examples
V22 Normal pregnancy
V22.0 Supervision of normal first pregnancy
V22.1 Supervision of other normal pregnancy
V22.2 Pregnant state, incidental
When beneficiaries are referred for specialty obstetric care, prior authorization must be obtained
for both outpatient and inpatient services.
Maternal Serum Alpha Fetoprotein and Multiple Marker Screen Test are cost-shared separately
(outside the global fee) as part of the maternity care benefit to predict fetal developmental
abnormalities or genetic defects. A second phenylketonuria test for infants is allowed if
administered one to two weeks after discharge from the hospital as recommended by the
American Academy of Pediatrics®.
Professional and technical components of medically necessary fetal ultrasounds are covered outside the
maternity global fee. The medically necessary indications include (but are not limited to) clinical
circumstances that require obstetric ultrasounds to estimate gestational age, evaluate fetal growth,
conduct a biophysical evaluation for fetal well- being, evaluate a suspected ectopic pregnancy,
define the cause of vaginal bleeding, diagnose or evaluate multiple gestations, confirm cardiac
activity, evaluate maternal pelvic masses or uterine abnormalities, evaluate suspected hydatidiform
mole, and evaluate the fetus’ condition in late registrants for prenatal care.
