Global maternity claims

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.

Indications include, but are not limited to:

  • Clinical circumstances that require obstetric ultrasounds to estimate gestational age
  • Evaluate fetal growth
  • Conduct a biophysical evaluation for fetal well-being
  • Evaluate a suspected ectopic pregnancy
  • Define the cause of vaginal bleeding
  • Diagnose or evaluate multiple gestations
  • Confirm cardiac activity
  • Evaluate maternal pelvic masses or uterine abnormalities
  • Evaluate suspected hydatidiform mole
  • Evaluate fetus condition in late registrants for prenatal care

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.

TRICARE claims information