General Information | PDF Version

• Definition of the Prenatal Care Coordination Benefit

  • Prenatal Care Coordination Goal

• Scope of Service
• Provider Information

  • Provider Eligibility and Certification

  • Subcontracting for Prenatal Care Coordination Services

• Recipient Information

  • Recipient Eligibility

    • Presumptive Eligibility

  • Medicaid Managed Care Coverage

  • Copayment

  • Freedom of Choice

Covered Services and Related Limitations | PDF Version

• Outreach
• Initial Assessment
• Care Plan Development
• Ongoing Care Coordination and Monitoring

  • Activities for Ongoing Care Coordination and Monitoring

    • Recipient Contacts

    • Collateral Contacts

    • Information and Referral

    • Assessment and Care Plan Updates

    • Recordkeeping

  • Provision of Services in Urgent Situations

  • Frequency of Ongoing Monitoring

  • Postpartum Services

• Health Education and Nutrition Counseling
• Recipient Records

  • Safeguarding Recipient Information

• Duplication of Services

  • Prenatal Care Coordinators

  • Other Care Coordinators

• Reduction or Termination of Ongoing Care Coordination Services.
• Other Limitations
• Noncovered Services

Billing Information | PDF Version

• Claim Submission
  • Electronic Billing
  • Paper Claim Submission
  • Where to Send Your Claims
• Claim Submission Deadline
• Billed Amounts
• Reimbursement
• Procedure Codes
• Diagnosis Codes
• Time Units
• Modifiers
  • Modifier for Second Pregnancy
• Follow-Up to Claim Submission

Appendix (some appendices are available in PDF only)

Please see the download list to obtain other appendices in PDF.
Learn about PDFs.

• Appendix 1: HCFA 1500 Claim Form Completion Instructions for Prenatal Care Coordination Services 
• Appendix 2: Completed Sample HCFA 1500 Claim Form - PDF (130kb)
• Appendix 3: Completed Sample HCFA 1500 Claim Form - Second Pregnancy - PDF (131kb)
• Appendix 4: Medicaid-Allowable Procedure Codes and Modifiers for Prenatal Care Coordination Services
• Appendix 5: Medicaid-Allowable Place of Service Codes and Type of Service Code for Prenatal Care Coordination Services
• Appendix 6: Rounding Guidelines for Prenatal Care Services
• Appendix 7: Medicaid Guidelines and Performance Measurements for Prenatal Care Coordination
• Appendix 8: Pregnancy Questionnaire - PDF (119kb)
• Appendix 9: Instructions for Completing the Pregnancy Questionnaire
• Appendix 10: Pregnancy Questionnaire Summary (Sample Format) - PDF (60kb)
• Appendix 11: Referral Form (Sample Format) - PDF (75kb)
• Appendix 12: Informed Consent to Release/Obtain Health Care Information Form (Sample Format) - PDF (64kb)
• Appendix 13: Care Plan (Sample Format) - PDF (91kb)
• Appendix 14: Prenatal Care Coordination Monthly Time Log for Ongoing Care Coordination and Monitoring (Completed Sample Format) - PDF (53kb)
• Appendix 15: Memorandum of Understanding (Sample Format) 
• Appendix 16: Prenatal Care Coordination Resource Guide
• Appendix 17: Information Regarding Transportation to Medical Appointments
• Appendix 18: Comprehensive Agency Outreach and Case Management Plan Requirements
• Appendix 19: Medicaid Maximum Fee Schedule for Prenatal Care Coordination Services.

List of Medicaid Handbooks
Interactive Version of the Prenatal Care Coordination Services Handbook
Service-Specific Updates for Prenatal Care Coordination Services

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