59430
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
3.22
Facility
$161.66
Non-Facility
$261.20
Documentation Required
- Recommended (per ACOG guidance cited in the CPB) components of prenatal care that women considering home birth should be offered (not described as coverage documentation requirements): 'group B Strep screening and treatment, genetic screening, as well as HIV screening.'
- No specific documentation requirements are stated in this Clinical Policy Bulletin.
Key Coverage Criteria
- None — Aetna considers planned deliveries at home and associated services not medically appropriate.
- Coverage of home births will be considered when mandated by law under plans subject to state mandates.
1 Active Policy
AETNA-CPB-0329 — Home Births
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.