Billing for twin deliveries under Medicaid can be complex due to varying state policies and specific coding requirements. To avoid claim denials, make sure your CMS-1500 form is filled out correctly. This guide covers CPT coding, modifier usage, documentation, and Medicaid-specific billing challenges, helping you bill twin deliveries the right way.
Understanding Medicaid’s Approach to Twin Deliveries
Medicaid’s reimbursement policies for twin deliveries vary by state. In many cases, Medicaid may reimburse for only one delivery code, even if both twins are delivered vaginally.
For example, a provider reported that billing both 59400 and 59409-59 for a vaginal twin delivery was denied, with Medicaid stating they only pay for one delivery code when both are vaginally delivered (source).
CPT Coding for Twin Deliveries
Vaginal Twin Delivery
- Twin A (primary): Report 59400 for routine obstetric care including antepartum, vaginal delivery, and postpartum care.
- Twin B (secondary): Use 59409 with modifier -51 or -59 depending on payer requirements to indicate multiple distinct deliveries.
These services must be properly documented in the correct fields of the CMS-1500 claim form.
Reference: Magnolia Health Plan’s Medicaid billing guide
Cesarean Twin Delivery
- Report 59510 (routine obstetric care with cesarean).
- Append modifier -22 if the cesarean delivery is significantly more complex due to the twin delivery (source).
Combined Vaginal and Cesarean Delivery
If one twin is delivered vaginally and the other via cesarean:
- Use 59510 for the cesarean delivery.
- Add 59409 with modifier -51 for the vaginal component (source).
Modifier Usage
- Modifier -22: Use to report increased complexity for cesarean twin deliveries. Documentation must support this. If denied and resubmission is needed, refer to Box 22 resubmission code instructions.
- Modifier -51: Used to report multiple procedures during the same encounter.
- Modifier -59: Signals that a procedure is distinct and separate from another on the same claim. Some Medicaid payers require it for Twin B.
Documentation Tips
- Detailed Operative Reports: Clearly document the delivery method for each twin, the timing, and any complications.
- State Medicaid Guidelines: Always consult your state’s Medicaid policy for delivery billing.
- Form Accuracy: Make sure your CMS-1500 form is completed correctly, especially sections related to procedures and modifiers.
- Claim Resubmissions: If a claim is denied, follow proper steps using Box 22 on the CMS-1500 form.
You may also need to bill additional services related to newborn care or delivery complications using appropriate CPT codes like 99464 or 99360.
What About the UB-04?
While most maternity claims are billed with the CMS-1500 form, institutional providers (e.g., hospitals) may need to submit claims using the CMS-1450 UB-04 form.
Final Thoughts
Accurate coding and documentation are essential to receiving full reimbursement for twin deliveries. Understanding Medicaid-specific rules, choosing the correct CPT codes, using modifiers correctly, and completing your claim form properly are all critical steps in the process.
For additional help, refer to our full guide to completing the CMS-1500 form or browse our medical billing resource center.