Fee Navigator

    Health Service Code 03.04B

    Initial prenatal visit requiring complete history and physical examination

    NOTE:
    1. May not be charged within 90 days of another comprehensive visit or consultation.
    2. May only be claimed once per pregnancy.
    3. Includes a full history, examination, initiation of the prenatal record and advice to the patient.
    Category:V Visit
    Base rate:$104.60

    AMA billing tips:

    • This service may only be claimed once per pregnancy per patient. In the event the pregnancy is not viable and the patient becomes pregnant again within 180 days of the previous 03.04B, text may be required to explain the situation in order to obtain payment for the second 03.04B.

      All criteria in Note 3 must be met in order to submit a claim for the service.

    Fee modifiers:

    TypeCode# of callsExplicitActionAmount
    CARECMXC30YesIncrease Base By$31.43
    TELETELESYesIncrease Base To120%

    Governing Rules:

    • 4.6.3

      Notwithstanding GR 4.6.1, an initial prenatal examination 03.04B may not be claimed within 90 days of another comprehensive visit or consultation. Comprehensive visit and consultation services are defined under GR 4.6.1. There must be an interval of 90 days between the first and second services.

    • 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.