Fee Navigator

    Health Service Code 03.03B

    Prenatal visit

    Category:V Visit
    Base rate:$37.02

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CARECMXV20YesIncrease Base By$15.70
    CARECMXV35YesIncrease Base By$31.43
    CMPXCMGP1 - 10YesFor Each Call Increase By$18.48
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 4.2.2

      Limited Visit: A limited assessment, of a patient, which includes a history limited to and related to the presenting problem, and an examination which is limited to relevant body systems, an appropriate record, and advice to the patient. It includes the ordering of appropriate diagnostic tests and procedures as well as discussion with the patient.

    • 5.2.3

      Services provided to additional patients seen during the same callback, or services over the limits specified in GR 15.11 may be claimed as:

      1. Deleted
      2. HSC 03.02A, 03.03A, 03.03B, 03.04A as appropriate, or
      3. the applicable procedure.
    • 8.1.1

      Obstetrical care is divided into its components. An initial prenatal visit 03.04B includes a full history, examination, completion of the prenatal record and advice to the patient. Usual prenatal care includes a prenatal visit, follow-up visits which would generally occur at four-week intervals to 32 weeks, followed by visits every second week to 36 weeks, then weekly visits until delivery. Additional visit or procedure items may be claimed as required for complicated pregnancies.

    • 8.1.2

      Prenatal visits (HSC 03.03B), emergency, outpatient and inpatient hospital visits may be claimed up to the time of delivery, including the day of delivery; except in the situation where delivery occurs within 24 hours of admission, in which case neither a hospital admission (03.04C) nor a hospital visit (03.03D) may be claimed.