General Rate Provisions and Payment

(1) Rate Determination. Rates of payment for the facility component of authorized freestanding birth center facility services to which 101 CMR 355.00 applies are the lowest of (a) the eligible provider's usual fee to the general public; (b) the eligible provider’s actual charge submitted; and (c) the schedule of allowable rates set forth in 101 CMR 355.03(5). (2) Individual Consideration and Nonlisted Procedures. Rates of payment for freestanding birth center services that are authorized but not listed in 101 CMR 355.00, services performed in unusual circumstances, and services whose fees are designated by the letters “IC” are determined on an individual consideration basis. (3) Terminated Procedures. The purchasing governmental unit determines payment on an individual consideration (IC) basis for any procedure that has been terminated after the procedure was initiated. (4) Services and Payments Covered under Other Regulations. Rules and payment rates for professional services of physicians, certified nurse-midwives, and certified nurse practitioners performed in freestanding birth centers are contained in 101 CMR 355.03(4). Regulation Title Regulation Number Rates for Surgery and Anesthesia Services Rates for Medicine Services Rates for Radiology Services (5) Fee Schedule HCPCS Code Fee Description 59400-TC $4,589.24 Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care (payment for the birthing person’s length of stay for an all-inclusive global facility obstetrical service without use of forceps) 99460-TC $1,422.31 Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant (all-inclusive global facility payment for newborn’s length of stay) S4005 IC Interim labor facility global (labor occurring but not resulting in delivery) (global facility payment for prepartum services when delivery occurs at another facility) (6) Provider Preventable Conditions. The following modifiers are used to report provider preventable conditions in accordance with 42 CFR 447.26, and result in nonpayment for services. Modifier Description PA Surgical or other invasive procedure on wrong body part PB Surgical or other invasive procedure on wrong patient PC Wrong surgery or other invasive procedure on patient