Effective July 1, 2020, providers will not be reimbursed for claims on or after this service date for a non-medically indicated early elective delivery (EED) performed at a hospital on a pregnant woman earlier than the 39th week of gestation. A non-medically indicated early elective delivery (EED) means the artificial start of the birth process through medical interventions or other methods, also known as labor induction, or the surgical delivery of a baby by a cesarean section for purposes or reasons that are not fully consistent with established standards of clinical care as provided by the American College of Obstetricians and Gynecologists (ACOG). EEDs are defined as scheduled cesarean sections or medical inductions performed prior to 39 weeks of gestation without medical indication. An EED is not justified solely by maternal request, availability of effective pain management, facility or provider scheduling issues.
For more information about EED reimbursement changes, visit UHCprovider.com/NJcommunityplan > Bulletins and Newsletters > Current Alerts & Bulletins > Bulletins and Newsletters > Early Elective Delivery Reimbursement Changes.