Billing rubric
The instruction behind the policy.
Compare source-backed research by payer, product, and phase. Each row keeps unknown fields visible and links to the original document.
4 of 4 source instructions
Exports include clinical review status. Source code references are not claim recommendations.
| Payer / product | Phase & conditions | Source instruction | Code references | Modifier / diagnosis | Other requirements | Evidence |
|---|---|---|---|---|---|---|
| Aetna Commercial · Medicare Advantage Clinical review pending | Antepartum
| The source describes applicable E/M with TH and pregnancy diagnoses for qualifying preventive visits. At four prenatal visits in 2026, it directs current antepartum guidelines. Instruction: provided | Not provided Excluded: Not provided | Modifier: TH Diagnosis: Pregnancy diagnosis; preventive status must be supported. | Category II: Not provided Cost share: Source distinguishes routine preventive visits from non-routine visits. Contact: Not provided More guidance expected: Yes | OfficeLink Updates, September 2026 (printed pages 8–10) ↗“This update applies to commercial and Medicare members.” Checked Sep 30, 2026 |
| Capital Blue Cross Commercial · Medicare Advantage · CHIP Clinical review pending | Any phase
| The November update extends TH beyond E/M to maternity-related procedure codes. Review FP-01.011 for the full service and encounter guidance. Instruction: provided | Not provided Excluded: Not provided | Modifier: TH Diagnosis: Not provided | Category II: Not provided Cost share: Not provided Contact: Not provided More guidance expected: Yes | September 2026 update to FP-01.011 ↗“Providers must append HCPCS modifier TH to all maternity-related procedure codes” Checked Sep 30, 2026 |
| Cigna Healthcare Commercial Clinical review pending | Antepartum
| The September notice directs continuation of existing maternity billing processes and contractual requirements while further guidance is pending. Instruction: provided | Not provided Excluded: Not provided | Modifier: Not provided Diagnosis: Not provided | Category II: Not provided Cost share: Not provided Contact: AMAMaternityCodes@CignaHealthcare.com More guidance expected: Yes | Update on maternity coding and reimbursement ↗“Cigna Healthcare is not changing its current maternity billing guidance at this time.” Checked Sep 30, 2026 |
| North Carolina Medicaid Medicaid FFS · Medicaid managed care Clinical review pending | Antepartum
| The source encourages eligible transition encounters to use E/M with TH. It preserves bundled options before 2027; this is not a universal requirement. Instruction: provided | 99202–99215 Excluded: Not provided | Modifier: TH Diagnosis: Appropriate ICD-10-CM, including weeks of gestation. | Category II: Not provided Cost share: Not provided Contact: 888-245-0179 More guidance expected: Yes | Transition to AMA maternity CPT 2027 code changes ↗“Health plans may not require the use of individual E/M codes in lieu of current bundled codes” Checked Sep 30, 2026 |