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
