BILLING Guideline for CPT Code 59425, 59409, S5100 and T1023

Incomplete Antepartum Care 

Service CPT

Billing for Incomplete Antepartum Care

59425 When billing for four to six prenatal visits
59426 When billing for seven or more prenatal visits with or without an initial visit


Billing for Multiple Deliveries For additional babies: 59409, 59514, 59612, or 59620   Modifier - 51 and 59


Oral and Maxillofacial Surgery

Do not use CPT procedure code 41899, as this is an unspecified code and will cause delay in payment for services

Locum Tenens and Reciprocal Billing
Q5 - Service furnished by a substitute physician under a reciprocal billing arrangement.
Q6 - Service furnished by a locum tenens physician


S5100 Day Care Services, Adult
1 Unit = 15 minutes
U2 modifier is no longer required when billing this service code.
POS -  12 Home 99 Other (Community)

Billing Presumptive Eligibility (PE) Determinations

T1023 to bill for PE determination

Administration of a Provider Purchased Adult Vaccine With or Without an Evaluation and Management (E/M) Visit

90471 to 90474 - If there is a significant, separately identifiable service, performed, at the time of the vaccine administration, an appropriate E/M code may also be billed with modifier 25

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