According to the policy statement on home delivery of the American College of Obstetricians and Gynecologists, labor and delivery, while a physiological process, clearly presents hazards to both the mother and fetus before and after birth. These hazards require standards of safety which are provided in the hospital setting and cannot be matched in the home situation. The Guidelines for Perinatal Care published by the American Academy of Pediatrics and American College of Obstetricians and Gynecologists state that the hospital, including a birthing center within the hospital complex, or a freestanding birthing center, provides the safest setting for labor, delivery, and the postpartum period. The use of other settings is not encouraged. Further, any facility providing obstetrical care should have the services listed as essential components for a level I hospital. This includes the availability of blood and fresh-frozen plasma for transfusion; anesthesia, radiology, ultrasound, electronic fetal heart rate monitoring and laboratory services available on a 24-hour basis; resuscitation and stabilization of all inborn neonates; nursery; and other services that are not available in the home setting.
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes not covered for indications listed in the CPB (not all-inclusive):
59400 - 59430
59510 - 59525
59610 - 59622
99199
99432
HCPCS codes not covered for indications listed in the CPB (not all-inclusive):
G0154
Services of skilled nurse in home health setting, each 15 minutes [not covered for planned deliveries at home]
S8415
Supplies for home delivery of infant
S9123 - S9124, T1000 - T1003, T1030 - T1031
Nursing care in the home [not covered for planned deliveries at home]
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
640.00 - 677
Complications mainly related to pregnancy, normal delivery and other indications for care in pregnancy, labor, and delivery, complications occurring mainly in the course of labor and delivery, and complications of the puerperium [not covered for planned deliveries at home]
V22.0 - V24.2
Supervision of pregnancy and postpartum care and examination [not covered for planned deliveries at home]
V27.0 - V27.9
Outcome of delivery [not covered for planned deliveries at home]
V30 - V39 with 4th digit 2
Liveborn infants according to type of birth, born outside hospital and not hospitalized [not covered for planned deliveries at home]
The above policy is based on the following references:
Bastian H, Keirse MJ, Lancaster PAL. Perinatal death associated with planned home birth in Australia: Population based study. BMJ. 1998;317(7155):384-388.
Olsen O, Jewell MD. Home versus hospital birth. Cochrane Database Syst Rev. 1998;(3):CD000352.
American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). Guidelines for Perinatal Care. 6th ed. Elk Grove Village, IL: AAP; 2007.
American College of Obstetricians and Gynecologists (ACOG). Statement on Home Delivery. Washington, DC: ACOG; September 1999.
American College of Obstetricians and Gynecologists (ACOG). Home births double risk of newborn death. ACOG Press Release. Washington, DC: ACOG; July 31, 2002.
Pang JW, Heffelfinger JD, Huang GJ, et al. Outcomes of planned home births in Washington State: 1989-1996. Obstet Gynecol. 2002;100(2):253-259.
McKenna P, Matthews T. Safety of home delivery compared with hospital delivery in the Eastern Region Health Authority in Ireland in the years 1999-2002. Ir Med J. 2003;96(7):198-200.
Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). Home births. College Statement. Statement No. C-Obs 2. East Melbourne, VIC: RANZCOG; November 2006.
American College of Obstetricians and Gynecologists (ACOG). Home births in the United States. ACOG Statement of Policy. Washington, DC: ACOG; approved May 4, 2007.
Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
Close Window
