Starting July 1, 2025, North Carolina Medicaid will implement two new F codes to enhance how providers document and track prenatal and postpartum care. These updates aim to improve maternal health and quality measures statewide.
What’s Changing?
The new Medicaid F codes allow providers to collect more accurate data on maternal health. This data will help identify care gaps and create opportunities for quality improvement.
| CPT Code | Description | Physician/NPP/LHD Services Guidelines |
| 0500F | Initial Prenatal Care Visit | Code reported to identify initiation of prenatal care. Report at first prenatal encounter with an obstetrical provider or other prenatal care practitioner. Report date of visit and in a separate field of the date of the last menstrual period. |
| 0503F | Postpartum Care Visit | Code reported to identify the comprehensive postpartum care visit. Postpartum visit can be to an obstetrical provider or other postpartum care practitioner, or PCP. Do not include postpartum care provided in an acute inpatient setting or other urgent/emergency room setting. |
These F codes do not replace global billing or current obstetric CPT codes. Instead, they improve the ability to track, bill, and support the care provided for expectant and new mothers.
Why Do These New Codes Matter?
NC Medicaid and Managed Care Plans require clearer insights into when prenatal and postpartum care occurs. Accurate coding will improve North Carolina’s HEDIS score for the Prenatal and Postpartum Care (PPC) quality measure. Beginning July 1, 2025, Medicaid will deny delivery claims if the code 0500F does not appear in the patient’s claim history.
How Should I Integrate These New Codes?
To successfully incorporate these codes into your workflow, take the following steps:
- Educate Your Team: Ensure billing staff and care managers understand the new codes and how to apply them correctly.
- Review Visit Types: Identify where the codes apply within your existing prenatal and postpartum visit structures.
- Claims Review: Fix any F code issues before July denials take place.
By clearly tagging the initial prenatal and postpartum visits, providers create a powerful picture of care timelines. This clarity helps identify gaps, strengthens coordination, and promotes better health outcomes for mothers and babies across North Carolina.