Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 1 - PHYSICIANS
Section 317:30-5-23 - Newborn care
Current through Vol. 42, No. 1, September 16, 2024
Claims for newborn care and circumcision are filed under the newborn's SoonerCare member ID number.
(1) When there is a newborn child and the mother is receiving SoonerCare benefits, an OKDHS form 08MA015E (FSS-NB-1) or other notification must be submitted to the county OKDHS office. If the mother is not already receiving SoonerCare benefits, an application will need to be completed. Services are billed using the appropriate codes contained in the Physician's Current Procedural Terminology (CPT).
(2) Neonatal intensive care codes (contained in the CPT) are used to report neonatal intensive care services. Certain procedures are bundled into the relevant inpatient neonatal critical care evaluation and management codes and are not reimbursed separately. All other medically-necessary procedures provided are considered for reimbursement using recognized coding and/or editing logic. Additional payment is allowed for standby at Cesarean Section, attendance at delivery or newborn resuscitation.
(3) Payment may be made for an evaluation and management service and newborn circumcision provided by the same provider on the same date of service.
Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff 7-27-95; Amended at 14 Ok Reg 2397, eff 2-5-97 (emergency); Amended at 14 Ok Reg 2928, eff 7-11-97; Amended at 16 Ok Reg 151, eff 10-14-98 (emergency); Amended at 16 Ok Reg 1429, eff 5-27-99; Amended at 17 Ok Reg 3199, eff 1-23-01 (emergency); Amended at 18 Ok Reg 1130, eff 5-11-01; Amended at 24 Ok Reg 2069, eff 6-25-07
