Maternity service changes

The Ministry of Health introduced changes to the claiming process for maternity services in November 2021.

PMS systems have been updated to reflect these changes and this will go a long way to guide providers to through the new claims available.

A guide to the changes and the complete 'notice' is available on the Ministry of Health website. 

In summary

• The majority of the changes impact on lead maternity carers, not on general practice.
• The term 'Non-LMC' has been replaced with 'primary maternity single services'.
• There are SIX single episode service codes that 'authorised providers' (GPs/NPs/practices) can claim.
• First trimester single services can be claimed for services between LMP and 13 weeks 6 days gestation, only for in-person (non telehealth) services, and only one claim per provider per day.

First Trimester single services

• For example pregnancy confirmation, follow up test results or care, advice about TOP.
• Replaces: Non-LMC first trimester (with or without threatened miscarriage, miscarriage or termination).
• Claim value: $75.

First trimester pregnancy loss

• In-person consultations – including up to 2 weeks after pregnancy loss
• Replaces: Part of LMC First and second trimester (first partial) and Non-LMC First trimester (with or without threatened miscarriage, miscarriage or termination).
• Claim value: $125.

Second trimester pregnancy loss

• 14 weeks – 19 weeks 6 days, in person, during pregnancy loss event +/-  a minimum of one post partum consultation.
• Replaces: N/A – this is new.
• Claim value: $165 (full) / $82.50 (partial – either in-person during event or minimum of one post-partum consultation).

Urgent single service

• When woman away from usual place, or unable to contact LMC. Documentation required includes: 
  • where the urgent service was provided antenatally, the woman’s gestation; or where the service was provided postnatally, the number of weeks and days postpartum; and
  • whether the woman is away from her usual place of residence; and
  • the name of the LMC (where the woman has an LMC); and
  • the avenues by which the woman has attempted and failed to contact her LMC and the back-up LMC; and
  • evidence of the provision of information to the LMC (where the woman has an LMC).
• Replaces: non-LMC urgent normal hours pregnancy care, non-LMC urgent out of hours pregnancy care and Non-LMC urgent postnatal care.
• Claim value: $44.50 (if usual GP and first trimester claim first trimester single service.) 

Transfer support              

• Accompanying woman or baby in the air or road ambulance =  contribute to the cost of the practitioner returning to their home or vehicle 
• Replaces: LMC labour and birth (rural support) (DA27(b)) and non-LMC labour and birth (rural support) (DB15(b)).
• Claim value: Less than 30 min = $50, 30-60min = $150, 60-120min = $300, >120min = $400. But also weighted according to a 'spoke' and 'hub' criteria for each birthing unit and hospital.

Rural support

• If rural LMC needs support and paediatrican / obstetrician not available
• LMC Labour and birth (rural support) (DA27(a)) and Non-LMC Labour and birth (rural support) (DB15(a)).
• Claim value: $556