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Benefits by Service: Nurse Midwife Services (October 2008) Definition/Notes

Note: Totals include 50 states and D.C.

"Benefits Covered" Totals

"Benefits Not Covered" Totals

Is the benefit covered?

Is there a co-payment requirement?

Yes: 14

No: 37

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Alabama
Yes			null	Fee for service, some services paid at 50% or 85% of physician fee	CN
Alaska
Yes				Fee for service at 85% of physician fee	CN
Arizona
Yes			Physician back-up required	Fee for service at 90% of physician fee	CN & MN
Arkansas
Yes			12 visits/year irrespective of setting included in limits for other specified practitioners	Fee for service at 80% of physician fee	CN & MN
California
Yes				Fee for service, some services performed in outpatient hospital setting paid 80% of fee	CN & MN
Colorado
Yes				Fee for service	CN
Connecticut
Yes				Fee for service	CN & MN
Delaware
Yes				Fee for service	CN
District of Columbia
Yes				Fee for service	CN & MN
Florida
Yes			10 prenatal visits/year, 2 postpartum visits/year, 2 home visits/year	Fee for service at 80% of physician fee	CN & MN
Georgia
Yes				Fee for service at 84.645% of CMS RBRVS rates for 2000	CN & MN
Hawaii
Yes				Fee for service	CN & MN
Idaho
Yes				Fee for service at 85% of physician fee	CN
Illinois
Yes				Fee for service at physician fee	CN & MN
Indiana
Yes				Fee for service	CN
Iowa
Yes				Fee for service	CN & MN
Kansas
Yes				Fee for service	CN & MN
Kentucky
Yes	A - $2/visit except maternity care			Fee for service at 75% of physician fee	A, B, C & D - See state-specific FN
Louisiana
Yes			null	Fee for service	CN & MN
Maine
Yes		Specified procedures and services		Fee for service	CN & MN
Maryland
Yes			1 visit/day	Fee for service	CN & MN
Massachusetts
Yes				Fee for service	CN & MN
Michigan
Yes	$2/office visit not associated with pregnancy or family planning			Fee for service	CN & MN
Minnesota
Yes	null			Fee for service	A & B - See state-specific FN
Mississippi
Yes	$3/visit		12 office, rural health or outpatient hospital visits/year, 36 nursing facility visits/year, 1 inpatient hospital visit/day (2 for ICU)	Fee for service at 90% of physician fee	CN
Missouri
Yes	$1/day		Services limited to women age 15 and older and infants up to 2 months	Fee for service	CN & MN
Montana
Yes	$4/visit			Fee for service, some services paid 90% of physician fee	A & B - See state-specific FN
Nebraska
Yes	$2/visit, not applicable to primary care services - see state-specific FN			Fee for service	CN & MN
Nevada
Yes				Fee for service	CN
New Hampshire
Yes				Fee for service	CN & MN
New Jersey
Yes				Fee for service at 70% of specialist physician fee	CN & MN
New Mexico
Yes	A - $5/visit, B - $7/visit non-preventive services - see state-specific FN			Fee for service	CN
New York
Yes				Fee for service	CN & MN
North Carolina
Yes	$3/visit		22 ambulatory visits/year included in limits with other specified practitioners - limits set annually by the legislature	Fee for service	CN & MN
North Dakota
Yes	$2/visit			Fee for service at 85% of physician fee	CN & MN
Ohio
Yes				Fee for service	CN
Oklahoma
Yes				Fee for service	CN
Oregon
Yes	A - $3/visit			Fee for service	A & B - See state-specific FN
Pennsylvania
Yes			12 prenatal and postpartum visits/year plus 1 postpartum visit included in delivery fee	Fee for service	CN & MN
Rhode Island
Yes				Fee for service	CN & MN - see state-specific FN
South Carolina
Yes	$2/visit - applicable to specified E&M services only			Fee for service	CN
South Dakota
Yes	$3/visit			Fee for service for high volume procedures, percentage of charge for low volume procedures and for supplies	CN
Tennessee
Yes					A & B - See state-specific FN
Texas
Yes				Fee for service, some services paid 92% of physician fee	CN & MN
Utah
Yes	A - $2/visit, B - $3/visit		C - primary care only, including routine physical exams	Fee for service, rural nurse midwives may be paid higher fees	A & B - See state-specific FN
Vermont
Yes				Fee for service	A & B - See state-specific FN
Virginia
Yes			Limited to non-high risk pregnancies	Fee for service	CN & MN
Washington
Yes				Fee for service	CN & MN
West Virginia
Yes				Fee for service	A & B
Wisconsin
Yes	$.50-$3, depending on service, maximum $30/year/provider			Fee for service at 90% of physician fee except injections	CN & MN
Wyoming
Yes				Fee for service at 83% of physician fee	CN
American Samoa
Yes					See territory-specific FN
Guam
No
Northern Mariana Islands
No
Puerto Rico
No
Virgin Islands
No

Definition/Notes: Link to Nurse Midwife Services Footnote


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