Maternity Claims: Multiple Birth Reimbursement

Date Issued: 12/2/2014

Beginning September 1, 2014, EmblemHealth began adjusting the payment for multiple births for members in GHI plans. Payment method for submissions of claims for the delivery of a multiple birth is as follows:

  • Payment is made for members, who deliver twins, triplets, quads, etc. for each vaginal delivery, or when the first baby is born vaginally and the subsequent babies are delivered via Cesarean section.
  • If multiple births are via C-Section only one procedure will be reimbursed (single or multiple births).
  • All appropriate coding guidelines must be completed to include appropriate diagnoses related to multiple births and applicable modifiers related to multiple births.
Delivery Method Procedure Code

Vaginal First Newborn 59400, 59409, or 59410

Subsequent Newborn(s) 59409 Modifier 51, 59

Vaginal Birth After Cesarean VBAC First Newborn 59610, 59612, or 59614

Subsequent Newborn(s) 59612 Modifier 51, 59

Vaginal Delivery followed by Cesarean Delivery (Vaginal delivery, then a Cesarean) First Newborn 59400, 59409 or 59410

Subsequent Newborn(s) 59514 Modifier 51,59

Cesarean First Newborn 59510, 59514 or 59515

Subsequent Newborn(s) No additional allowances for subsequent newborns delivered via the same incision reimbursed under the first newborn’s claim*

Cesarean delivery, following attempted vaginal delivery after previous cesarean delivery First Newborn 59618, 59620, or 59622

Subsequent Newborn(s) No additional allowances for subsequent newborns delivered via the same incision reimbursed under the first newborn’s claim

Diagnoses Codes Required

Diagnosis Description

651.01 Twin pregnancy, delivered

651.1 Triplet Pregnancy, delivered

651.21 quadruplet pregnancy, delivered

651.31 Twin pregnancy with fetal loss and retention of one fetus, delivered

651.41 Triplet pregnancy with fetal loss and retention of one or more, delivered

651.51 Quadruplet pregnancy with fetal loss and retention or one or more, delivered

651.61 Other Multiple pregnancy with fetal loss and retention of one or more fetuses, delivered

V33.00 Twin, unspecified whether mate stillborn or liveborn, born in hospital, delivered without mention of cesarean delivery

V33.01 Twin, unspecified whether mate stillborn or liveborn, born in hospital, delivered by cesarean delivery

V32.00 Twin, mate stillborn, born in hospital, delivered without mention of cesarean delivery

V32.01 Twin, mate stillborn, born in hospital, delivered by cesarean delivery

V31.00 Twin, mate liveborn, born in hospital, delivered without mention of cesarean delivery

V31.01 Twin, mate liveborn, born in hospital, delivered by cesarean delivery

V34.00 Other multiple, mates all liveborn, born in hospital, delivered without mention of cesarean delivery

V34.01 Other multiple, mates all liveborn, born in hospital, delivered by cesarean delivery

V35.00 Other multiple, mates all stillborn, born in hospital, delivered without mention of cesarean delivery

V35.01 Other multiple, mates all stillborn, born in hospital, delivered by cesarean delivery

V36.00 Other multiple, mates liveborn and stillborn, born in hospital, delivered without mention of cesarean delivery

V36.01 Other multiple, mates liveborn and stillborn, born in hospital, delivered by cesarean delivery

V37.01 Other multiple, unspecified whether mates stillborn or liveborn, born in hospital, delivered by cesarean delivery

651.91 Unspecified multiple gestation, delivered

651.71 Multiple gestation following (elective) fetal reduction, delivered, with or without mention of antepartum condition

V27.2 Twins, both live born

V27.3 Twins, one liveborn and one stillborn

V27.4 Twins, both stillborn

V27.5 Other multiple birth, all liveborn

V27.6 Other multiple birth, some liveborn

V27.7 Other multiple birth, all stillborn