Telemedicine and Pregnancy Care
Issue Brief
KFF analyzed a sample of medical claims obtained from the 2017 IBM Health Analytics MarketScan Commercial Claims and Encounters Database, which contains claims information provided by large employer plans. We only included claims for women ages 15-44 who were enrolled in a plan for more than half a year. Claims were de-duplicated, meaning they were limited to one claim per person per day. We defined outpatient telemedicine utilization to include any clinical interaction between a patient and health care provider (physician or non-physician), delivered via live-video, remote patient monitoring, store and forward technology or telephone. Telehealth claims were captured using procedure modifiers specific to telehealth, including GT and 95 for synchronous telecommunication and GQ for asynchronous telecommunication, and “place of service 2” to indicate delivery by telemedicine. We also analyzed the following procedure codes specific to telehealth: 99441-99444, 98966-98969, G2010, G2012, G9868-G9870, S9110, G0071. Inpatient and emergency department uses of telemedicine were excluded, as were provider-provider interactions. Codes used to capture pregnancy-related care are as follows: Z34, Z39.2, O09, O10-16, O20-29, O30-48, O85-92, 094-O9A, Z34, Z39.2, O09, O10-16, O24, F53, F53.0, F53.1, O99.34, O99.340, O99.341, O99.342, O99.343, O99.344, O99.345, O90.6, B37.89, L01.00, O91.02, O91.03, O91.13, O91.219, O91.22, O91.23, O92.03, O92.13, O92.20, O92.29, O92.3, O92.4, O92.5, O92.6, O92.70, O92.79, Q83.8, R20.3, Z39.1. CPT codes for ultrasound imaging in pregnancy were also analyzed: 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76818, 76819, 76825, 76826).
Traditional prenatal care models typically recommend 1 visit per month in the 1st trimester, 2 visits per month in the 2nd trimester and 1 visit per week in the 3rd trimester. ACOG now recommends all patients are seem in the first 3 weeks postpartum, but traditionally patients were seen at 6 weeks postpartum.
ACOG recommends at least weekly or biweekly blood pressure measurement for women with gestational or chronic high blood pressure.
These requirements apply to most private plans – including individual, small group, large group, and self-insured plans in which employers contract administrative services to a third party.
These requirements do not apply to traditional Medicaid programs.