Global maternity involves the billing process for maternity-related beneficiary claims. After confirming that a patient is pregnant, all charges related to the pregnancy are grouped under one global maternity diagnosis code as the primary diagnosis.
When TRICARE Prime (TRICARE Prime, TPR, TYA Prime) beneficiaries are referred for specialty obstetric care, the Primary Care Manager (PCM) submits a service request notification to Humana Military. Professional and technical components of medically necessary fetal ultrasounds are covered outside of the maternity global fee.
Maternal serum alpha fetoprotein and multiple marker screen test are cost-shared separately (outside of the global fee) as part of the maternity care benefit to predict fetal developmental abnormalities or genetic defects.
A second phenylketonuria test for infants is allowed if administered one to two weeks after discharge from the hospital as recommended by the American Academy of Pediatrics.