Multiple births are covered and eligible for reimbursement consideration by the Company.
The Company has established the attached requirements for reporting of multiple births. Refer to Attachments A, B, C, and D for reporting requirements and examples of multiple birth coding scenarios.
The codes listed in the Coding Table of this policy are eligible for reimbursement consideration.
Inclusion of a code in this policy does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.
The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the health care professional's office, hospital, nursing home, home health agencies, therapies, and test reports.
The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.